Railways: Brighton to London Line
	 — 
	Question

Lord Berkeley: To ask Her Majesty's Government whether they will safeguard Uckfield station and the rail track of the former Uckfield to Lewes route for possible future use to provide additional capacity to the main Brighton to London line.

Earl Attlee: My Lords, there are no current plans to issue safeguarding directions. However, the former Uckfield to Lewes route is safeguarded by both Wealden and Lewes district councils in their local plans.

Lord Berkeley: My Lords, I am very grateful to the Minister for that Answer. Is he aware that East Sussex County Council has plans to build a road across the formation outside Uckfield which would, of course, completely prevent the line being reopened? Furthermore, is he aware that British Rail Property Board, which, as the House will know, is being abolished, is trying to sell off all its surplus land, which includes the land of the old Uckfield station, which, again, is essential to the reopening of this line? Will he instruct the property board not to do that and to keep this and other similar pieces of land for future reopening?

Earl Attlee: My Lords, the noble Lord raised two points, the first of which is the road. One of the benefits of the proposed scheme is that it allows for the building of a bridge at a later stage should that be necessary. In fact, the scheme makes it easier to open the line, should that be necessary, because to the west of the proposed road crossing is a level crossing, which would be unacceptable if you wanted to open the railway.
	The noble Lord asked about the BRPB and whether we would give it directions. No, we will not. It is not necessary. We are absolutely confident that nothing has been done that will compromise the ability to the open the railway at some point in the future, should it be desirable to do so.

Lord Bradshaw: Will the Minister widen his consideration just beyond this line. There are a number of noble Lords who have in their areas of interest railway lines that could be reopened with advantage in the future. Surely the land concerned should be vested in Network Rail, which in July last year pronounced the Uckfield to Lewes line of strategic importance. There are many other such lines, of which one example is Oxford to Cambridge. This has been made almost impossible to open between Bedford and Cambridge because of building.

Earl Attlee: My Lords, it is important to ensure that disused railway lines could be reinstated if it was necessary. The difficulty with my right honourable friend the Secretary of State issuing safeguarding directions is that he can do so only if it is intended to reopen the railway line, not to make it possible. In addition, if he does give safeguarding directions, it can result in compensation to developers.

Baroness Whitaker: My Lords, does the Minister accept that his words "at some point in the future" are not very consoling to south-east commuters, of whom I am one, who regularly have to stand on overcrowded trains at certain times of the day?

Earl Attlee: My Lords, the noble Baroness makes an extremely important point. We all know that at peak periods, the commuter railway lines south of London are all running at peak capacity. One difficulty is that we cannot easily increase the capacity to the main line terminals. In the case of Uckfield to Lewes, one of the bottlenecks is East Croydon, so even if we increased capacity in that area on the south of the line, you would still encounter the bottleneck at East Croydon, and there is very little we can do about that.

Lord Dubs: My Lords, does the Minister agree that many people believe that the Beeching cuts represented an act of terrible vandalism in the previous century? There are local campaigns to bring back many small railway lines up and down the country that have fallen into disuse because of Beeching. Can the Government at least say that they will encourage local initiatives to help us restore those railway lines? They have environmental benefits and tourist benefits. If the Government were to say that that is their policy, many of us would be very grateful.

Earl Attlee: My Lords, it is great that there are local initiatives to reopen lines-to make my department think carefully about that-but there has to be a good business case.

Lord Dholakia: My Lords, does the Minister accept that Gatwick Airport is a very popular destination for those travelling between London and Brighton? The number of passengers has increased. Secondly, does not the maximum use of the line between Victoria and Brighton demonstrate the need to preserve an alternative method, especially when this expansion of the Brighton line is exhausted?

Earl Attlee: My Lords, I fully accept that the Brighton line is running at capacity, but this particular scheme will do nothing to relieve the bottleneck. For instance, the path between Sevenoaks and Orpington is just twin track and there are no more train paths available at the peak period.

Lord Rosser: Nearly all line reopenings that have taken place have proved successful and have more than met projected passenger figures. Can the Minister say whether other lines are being considered for reopening? In particular, what is the current position with the reopening of the Skipton to Colne route and the safeguarding of that route?

Earl Attlee: My Lords, the Skipton to Colne route is a little far from Uckfield and Lewes. I can point to the dualling of the Swindon to Kemble line, which is very expensive but will bring many benefits. I see the Leader of Her Majesty's Opposition nodding her head enthusiastically.

Lord Berkeley: My Lords, I am very grateful to the Minister for the answers that he has given to various colleagues on my original Question. Lewes-Uckfield is in Network Rail's route utilisation strategy, which was published last year, so a lot of people in Network Rail must think that there is demand there.
	The Minister said that if the Secretary of State was asked to give some assurance or make some designation on certain routes, the developers might try to claim compensation. Given the time that it takes to develop any of these new railway lines-noble Lords have given different examples-surely there is a case for looking at the policy again so that routes can be safeguarded even for 10 or 20 years. It may take that time to get a new project off the ground.

Earl Attlee: My Lords, we do not think that that route will need to be opened within the next 20 years.

Legislative Timetable
	 — 
	Question

Lord Soley: To ask Her Majesty's Government whether they have any proposals to review and revise their legislative timetable.

Lord Strathclyde: My Lords, like every other Government before us, we intend to enact the legislative programme set out in the Queen's Speech by the end of the Session. We have no plans to review that objective.

Lord Soley: Does the Leader of the House accept that there is concern in all parts of the House, including among his own Back-Benchers, about the amount of ill-drafted legislation being presented, resulting in Bills being withdrawn or changed? The situation has been made increasingly complicated, in ways which we all understand, by deals that have to be done within the coalition, which makes it more difficult to compromise after the event. However, does that not mean that it is vital that the Government go the extra mile to liaise with the other political parties and Cross-Benchers in this House to deliver an outcome that gets us through? Otherwise this House will be sitting on Christmas Eve, and we all know it.

Lord Strathclyde: My Lords, I was not aware of the noble Lord's concerns. However, he is entirely right that the Government wish to go the extra mile with our own Benches, with coalition partners, Cross-Benchers and, indeed, with members of Her Majesty's loyal Opposition, and that is precisely what we do. That is one reason why we spend so much time on legislation. Noble Lords will remember the 20 days in Committee that we spent on the PVSC Bill earlier this year. I wonder whether they feel that that time was well spent.

Lord Ryder of Wensum: Exactly two years ago, on 5 October 2009, at the Conservative Party conference in Manchester, the then shadow Leader of the House of Commons, now its Leader, Sir George Young, stated:
	"Conservatives will legislate less, but we will also legislate better. So today I can announce that we will abolish the practice of automatically guillotining government bills".
	Why have Sir George and the Government broken those two promises?

Lord Strathclyde: My Lords, on the first point, I am delighted to tell my noble friend that in the first Session of the last Labour Administration, in 2005-06, 4,005 pages of legislation were enacted. So far this Session, which is longer than the 2005-06 one, we have passed only 1,392 pages of legislation. As for automatic timetabling in another place, that is up to the procedures there. However, I understand that most of that timetabling is agreed with the Opposition, very often without a vote.

Baroness O'Neill of Bengarve: Does the noble Lord the Leader of the House consider that it might help both Houses if legislation were drafted at an earlier stage? At present, I understand that departments of state receive a budget for parliamentary counsel to start drafting only when they have a guarantee that such legislation will be in the forthcoming Queen's Speech. That is too late, and I believe that we might have better drafted legislation that we could deal with more expeditiously if that were changed. It does not require legislation to change it.

Lord Strathclyde: My Lords, I broadly agree with the noble Baroness. She will welcome the fact that the Government are committed to promoting other forms of scrutiny and have already published a number of Bills for pre-legislative scrutiny in this Session alone. We are currently scrutinising in pre-legislative scrutiny some six Bills, including clauses relating to individual electoral registration and electoral administration.

Baroness Royall of Blaisdon: In relation to the PVSC Bill, I suggest that noble Lords may wish to look at comments made recently by the noble Baroness, Lady Warsi, and the noble Lord, Lord Rennard, on the boundary proposals. Many noble Lords, and certainly colleagues down the Corridor, might think that we did a jolly good job in this House.
	Does the Leader of the House agree that it is preferable for this House to sit in the same weeks as the House of Commons? We are two Houses but one Parliament. Can we have the noble Lord's assurance that next year we will not sit during party conference weeks? To do otherwise is not good for the smooth running of business, not good for Parliament and not good for politics. Some of us in this House are proud to be politicians and we wish to participate in our party conferences.

Lord Strathclyde: My Lords, I have received a number of representations from noble Lords all around the House who are very opposed to sitting in September and would infinitely prefer to sit earlier in October and sometimes even later in July. That is something that it is right for the usual channels to discuss. Of course we are one Parliament. We are also two Houses. We have different rules and regulations and are not the same in that respect. We deal with legislation very differently.

Lord Maclennan of Rogart: My Lords, can my noble friend the Leader of the House give some indication of the progress of his consideration, and that of the Government, of the recommendations of his group on the working practices of the House, which gave some consideration to the programming of Bills in another place and made some suggestions that might help to ease the pressure and enhance the careful deliberation on these Bills?

Lord Strathclyde: My Lords, I am glad to say that the Procedure Committee will be meeting on 24 October and a number of the proposals made by my noble friend's group, the Leader's Group on Working Practices, will be debated and then brought to the House, hopefully for agreement.

Lord Grenfell: My Lords, would the noble Lord the Leader of the House agree that it would be a very good idea if the usual channels would not do what they did recently over the Armed Forces Bill and make an agreement that matters discussed on Report would not be voted on until Third Reading? This is not in keeping with what the Companion says, nor is it particularly acceptable that we should be told that this is a one-off that does not set a precedent. When you do something you set a precedent and the only question that is open after that is whether it is going to be followed. My fear is that this could be followed because we have opened a door that should have been kept closed.

Lord Strathclyde: I agree with the noble Lord: I have never accepted this line that something is not a precedent when it so clearly is, and I would not have used that argument. Of course, usual channels make agreements on a whole range of matters in relation to how we deal with business on a daily basis. That is for the benefit of the House as a whole and for good order in the House, and I think that was so with the recent decision that took place earlier on this week.

Apprenticeships: Dyslexia
	 — 
	Question

Lord Addington: To ask Her Majesty's Government what progress they have made in making apprenticeships available to those with dyslexia.

Lord Addington: My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and draw attention to my declaration in the register of interests.

Baroness Wilcox: My Lords, the Government recognise that there are issues with delivery that can make it difficult for people with dyslexia to get the English qualifications that apprenticeships require. We want to ensure that all learning providers offer the right provision and support, and are challenging these providers' representatives to see what more their members can do to make this work. I know that assessment arrangements for key skills are a particular concern to my noble friend Lord Addington and I assure him that this qualification will be phased out of the apprenticeship by the autumn of next year.

Lord Addington: I thank my noble friend for that Answer. I am sorry to have to return to this subject yet again. I hope the Government can give us an assurance that they are looking at finding a way through this and give us some sort of timescale. With that in mind, could the Government please tell us whether any precedent that is set in other parts of the education department is appropriate to be taken as a whole to this area? If you can get through the A-level system and to university, surely you should be allowed to get through the apprenticeship system.

Baroness Wilcox: My noble friend rightly repeats a worry and a question that he has over the fact that using the key skills system for the apprenticeships is extremely difficult. We are looking, as he knows, at how we can improve access. There is no doubt that to encourage employers to take as many apprentices as possible is good for our country and we want to use all the talents that we have. That means harnessing able and disabled students wherever possible.

Lord Martin of Springburn: My Lords, would the noble Baroness consider the fact that when I was an apprentice those who were most helpful to the apprentices in the factory were normally the journeymen over the age of 50 who had more patience and tended to mentor the young people, not only in their trade but in their behaviour and other matters? A large number of men and women are unemployed and retired and could be used for mentoring apprentices. Could this be considered by the Government? By the way, I welcome the Government's action in encouraging apprenticeships.

Baroness Wilcox: I agree with the noble Lord. My father was an apprentice and he, too, became a journeyman, which is a wonderful thing. Perhaps we can find a use in that way. I will take this back and discuss it, and will come back to the noble Lord.

Lord Young of Norwood Green: Can the Minister guarantee that, given the importance of assisting all disabled people, especially the young, and the record levels of youth unemployment, there is sufficient budget to achieve this objective? If the Government have found a spare £250 million to spend on weekly bin collections, would it not have been better spent on encouraging more than the current 4 per cent of employers to provide apprenticeships?

Baroness Wilcox: I think the noble Lord knows that we are taking forward the work that he started and I hope that he is pleased with the way we are doing that. We are allowing the money that is needed to do this work, which is so important to us. There is no question that the bins come first.

Scotland: Civil Service
	 — 
	Question

Lord Foulkes of Cumnock: To ask Her Majesty's Government what responsibility the Cabinet Secretary has for the work of the civil service in Scotland.

Lord Wallace of Saltaire: My Lords, the Cabinet Secretary is also the head of the UK Civil Service, including those parts supporting the devolved Administrations in Scotland and Wales.

Lord Foulkes of Cumnock: I thank the noble Lord for that clarification. Is the Minister aware that the Conservative, Liberal Democrat and Labour leaders in the Scottish Parliament have all made official protests over Sir Peter Housden, the Scottish Permanent Secretary, advising the SNP Government on tactics and policy in relation to the break-up of the United Kingdom? Surely it is the responsibility of Sir Gus O'Donnell to say to Sir Peter Housden that he should be advising the SNP Government only on devolved areas and not on matters which are reserved to this Parliament, particularly those which are politically sensitive.

Lord Wallace of Saltaire: My Lords, I should of course declare a family interest. A relative of mine campaigned actively for Scottish independence and was executed by the English. I do not think that it is appropriate for a Minister to comment on the behaviour of a senior civil servant. I have read the Scottish press for the past week and I am well aware that the leaders of the three opposition parties in Scotland have written to the Cabinet Secretary. I will ensure that a copy of his reply, when it is ready, is placed in the Library of the House.

Lord Lang of Monkton: My Lords, is it not one of the strengths of the United Kingdom Civil Service that it is a United Kingdom body? In the past, great advantage has arisen for both sides when Scottish civil servants have served in United Kingdom departments and vice versa. Will my noble friend ensure that he makes every possible effort to prevent any diminution of this historic trend which might undermine the union?

Lord Wallace of Saltaire: My Lords, there are civil servants in Scotland working for the UK Government as well as civil servants in Scotland working for the Scottish Executive. This is a single Civil Service and there is extensive interchange. Indeed, the Permanent Secretary in Scotland about whom these complaints have been made has worked for a number of other institutions within the UK. Perhaps I might read the relevant parts of the Scottish version of the Civil Service Code, which was first issued in 2006. I shall quote from the 2010 version. It states:
	"As a civil servant, you are accountable to Scottish Ministers, who in turn are accountable to the Scottish Parliament".
	A footnote adds:
	"Civil servants advising Ministers should be aware of the constitutional significance of the Scottish Parliament and of the conventions governing the relationship between the Scottish Parliament and the Scottish Executive".
	Perhaps I may add that the next paragraph states that,
	"'impartiality' is acting solely according to the merits of the case and serving equally well Governments of different political persuasions".

Lord Sewel: To go a little further on this, generally, would it be proper for any Permanent Secretary at the Scottish Executive to give policy development advice to Scottish Ministers on constitutional matters when the constitution is clearly and explicitly a reserved matter? Secondly, is it proper for the Permanent Secretary of the Scottish Executive to make clear in public his personal views on a matter of controversial policy?

Lord Wallace of Saltaire: My Lords, on the second of those two questions, my understanding is that this was an internal blog. Noble Lords will have their views on the advisability of blogging. It was leaked to the Scottish edition of the Daily Telegraph. There might be a certain lack of wisdom there.
	On the first question, once we have a devolved Government, although constitutional matters are reserved to the UK Government they are bound to be discussed within the Scottish Government. How far civil servants should offer advice is an important question. There is also a director-general for constitutional reform in the Cabinet Office.

Lord Butler of Brockwell: My Lords, will the Minister confirm that, just as it is the duty of the rest of the Civil Service to support the policies of the Administration that it serves, so it is the duty of the civil servants in Scotland to advise on the policies of the Scottish Executive?

Lord Wallace of Saltaire: My Lords, I entirely agree with that. It is important that the Civil Service working for the Scottish Government commands the confidence of Scottish Ministers of the day, regardless of their political complexion, just as it is for civil servants in Whitehall working for the UK Government.

Lord Forsyth of Drumlean: My Lords, I recall being given a wigging by the noble Lord, Lord Butler, when he was Cabinet Secretary and I was Secretary of State for Scotland, for issuing an official press release from the Scottish Office in which I used the term "tartan tax". Although my Permanent Secretary approved it, the then Cabinet Secretary told me that it was inappropriate for a Scottish Office press release to contain something that might be politically contentious. I accepted that advice: he was quite right and I was in the wrong. So what on earth is going on when the Permanent Secretary for the Scottish Executive circulates what is described as an internal blog-a newsletter-to civil servants in the Scottish Office, which, among other things, advised going to see a play about an army of occupation in 11th-century Scotland which he said,
	"does genuinely speak to our present condition as a nation"?
	What on earth are this Government doing in standing aside? Surely it is the absolute duty of the Cabinet Secretary to maintain the impartiality of the Civil Service, which is a centrepiece of our constitution.

Lord Wallace of Saltaire: My Lords, the noble Lord will recall that on an earlier occasion the SNP strongly recommended that the population of Scotland go and see that dreadful film "Braveheart", one of the most historically inaccurate films that I am aware of.

Lord McFall of Alcluith: My Lords, the Minister says that he should not criticise civil servants' actions or behaviour. Why is that the case when the Permanent Secretary crosses a line that he should not? Will the Minister ensure that the Cabinet Secretary writes a letter to him, which is then placed in the House of Commons Library so that we can ensure that the proper constitutional arrangements are maintained in this country?

Lord Wallace of Saltaire: My Lords, I have already said that the Cabinet Secretary will write a letter in response to the three opposition leaders in Scotland. As the noble Lord knows well from the press, the Cabinet Secretary has already visited Edinburgh and a copy of the letter to those opposition leaders will be placed in the Libraries of both Houses.

Lord Stephen: My Lords, I first thank the noble Lord, Lord Foulkes, for raising this important and controversial issue. Is the Minister aware that most people in Scotland would far rather that senior civil servants, particularly such highly paid ones, spent their time improving the education system, health service and transport networks in Scotland, than pandering to the party political objectives of our First Minister? This is a serious issue. The core issue should not be the independence of Scotland but the independence, neutrality and objectivity of our civil service. When that is struck at, as has clearly happened in this instance, it is very worrying not just for Scotland but for all parts of the United Kingdom.

Lord Wallace of Saltaire: My Lords, I hesitate to get too embroiled in current political arguments in Scotland. The coalition Government do not agree with the SNP Administration on Scotland's future but they are an elected Administration with a policy programme that their Ministers wish to pursue. In delivering that programme for Ministers, all civil servants must comply with the appropriate ministerial code.

Lord Soley: Does the Minister accept that there is a need for a policy on the United Kingdom? Many of us in this House are concerned that no one is speaking up for the advantages of keeping the United Kingdom united. If we are not careful, the arguments for splintering, dividing and breaking away will get very strong. The Government need a policy that advances the arguments in favour of keeping the United Kingdom united. Let us put our heads above the parapet and defend it.

Lord Wallace of Saltaire: My Lords, I entirely agree with that. This Question, however, was about the division between what is political and what is administrative; what it is appropriate for the Civil Service to do and what it is appropriate for politicians to do. I am a strong supporter of the union myself, although I am not a unionist fundamentalist, as the Scottish newspapers are apparently alleging some are. We are finding a new balance between the devolved Administrations and the London Administration. It is very important that we all engage in the active debate on what that balance should be, but that is a political activity.

Lord Selkirk of Douglas: Would the Minister accept the principle that it is extremely desirable that civil servants should remain impartial, especially in the context of a referendum on whether the United Kingdom should or should not remain in existence? Is it not extremely important that individual civil servants should be like Caesar's wife-above suspicion?

Lord Wallace of Saltaire: I am never sure about Caesar's wife. One of the things I have learned in government is that special advisers-political advisers-are a very useful way of maintaining the distinction between what is political and what is impartial Civil Service advice. That is a distinction that I think everyone here-and, I hope, everyone in Edinburgh-wishes to maintain.

Lord Hughes of Woodside: This is asking the wrong question. The question is not whether there should or should not be a political debate. We are all agreed on that. The problem is that of civil servants entering that political debate. That should not happen, ever. The Minister should make that absolutely clear.

Lord Wallace of Saltaire: I entirely agree with that. Discussions are under way to ensure that the Civil Service remains impartial.

Financial Services and Markets Act 2000 (Exemption) (Amendment No. 2) Order 2011

Medicines Act 1968 (Pharmacy) Order 2011

Freedom of Information (Designation as Public Authorities) Order 2011

European Union (Definition of Treaties) (Second Agreement amending the Cotonou Agreement) Order 2011

Public Services Reform (Scotland) Act 2010 (Consequential Modifications of Enactments) Order 2011

Incidental Flooding and Coastal Erosion (England) Order 2011

Electricity and Gas (Internal Markets) Regulations 2011
	 — 
	Motions to Refer to Grand Committee

Moved By Lord Strathclyde
	That the draft orders and regulations be referred to a Grand Committee.
	Motions agreed.

Procedure Committee
	 — 
	Motion to Resolve

Moved By Lord Strathclyde
	That, as proposed by the Procedure Committee, and notwithstanding the normal practice of the House in the conduct of Divisions, any Member of the House with restricted mobility who satisfies conditions A and B below shall be entitled to vote in his or her place in the Grand Committee in any Division in the Chamber occurring while the Grand Committee on the Welfare Reform Bill is sitting in Committee Room 4A;
	Condition A
	The Member has notified the Clerk of the Parliaments of his or her intention to take part in the Grand Committee on the Welfare Reform Bill and to make use of this entitlement at least 24 hours in advance of the sitting of the Grand Committee in which he or she first proposes to make use of the entitlement;
	Condition B
	The Member is present in the Grand Committee room in order to be told by the Clerk by the time the question is repeated three minutes after a Division is called in the Chamber.

Lord Strathclyde: My Lords, the second Motion in my name on the Order Paper is largely self-explanatory but perhaps I may give some background to it. We are conscious that, if there should be a Division in the House while the Grand Committee is meeting in Committee Room 4A, and many Members with restricted mobility are taking part in that Grand Committee, it could be challenging for them all to make their way to the Chamber in order to vote within the eight minutes allowed. The Motion therefore seeks to address that concern by allowing Members of the House with restricted mobility to vote in their place in Committee Room 4A during sittings of the Grand Committee on the Welfare Reform Bill, subject to certain conditions, and only if they so wish.
	A paper in my name setting out the proposal embodied in this Motion was circulated to the Procedure Committee during the Recess and received the unanimous support of the members of that committee.
	I should emphasise that this entitlement would be a one-off, limited to the Grand Committee on this particular Bill, and deviating from the normal practice of the House in the conduct of Divisions only on account of the potential concentration of Members with mobility restrictions participating in the proceedings.
	A Grand Committee on the Welfare Reform Bill presents a unique set of circumstances, in the light of which I believe that we should make what adjustments we can to allow all noble Lords, including those with mobility restrictions, to play a full part not only in the work of the Grand Committee but also in any Divisions that take place in the Chamber. That is what the Motion is about and I hope that the House will support it today. I beg to move.

Lord Foulkes of Cumnock: I hesitate to try the patience of the House, having had such a useful discussion earlier in relation to Scotland. I welcome this Motion from the Leader of the House, as it will be of great help to people of reduced mobility in the Grand Committee to enable them to vote in the House. However, it is unfortunate that we have had to go this way. It has happened only because the Government, and the government Chief Whip in particular, saw fit to force on this House that all sittings of the Welfare Reform Bill Committee should be held upstairs in Committee Room 4A. That has resulted in what I understand to be substantial expenditure of many thousands of pounds on that Committee, when a number of the sittings could have been held here in the Chamber of the House. That would have been much more convenient for all of us, much better for the public, much better for people of reduced mobility and much better in every way.
	I was in the Grand Committee the other day and the possibility was raised, as it has been raised elsewhere, that if the Grand Committee itself were to ask that certain parts of the Bill be held on the Floor of the House, particularly those that relate to people with disabilities, the House might reconsider the question and have at least one or two sessions dealing with these particular items on the Floor of the House. There appears to be some time. On Monday, the House rose before six o'clock; on Tuesday, it rose before eight o'clock; and there are in the forthcoming programme days on which there are no matters of any great substance to debate compared with the Welfare Reform Bill. Therefore, it would be really helpful to all of us if issues of particular contention could be taken on the Floor of the House and if the House could be given an opportunity to reconsider this matter.

Lord Strathclyde: My Lords, I am very grateful for the noble Lord's support of this Motion. I am glad to have that, but I cannot agree with him on most of the rest of what he said, mainly because the House has already decided that the Committee stage of the Bill should be in a Grand Committee. Earlier today we had a Question from the noble Lord, Lord Soley, about the amount of legislation that we have. It was decided a long time ago that, if we are to try to close at 10 o'clock at night, we need to put Bills into Grand Committee. There are many important Bills before us and the principle of Grand Committee has been well established.
	I understand that there is also an advantage in going to Committee Room 4A. More Members can participate overall compared with the Moses Room; more members of the public who wish to view the proceedings can get in compared with the Moses Room; and, indeed, there are more places for wheelchair-using members of the public to view proceedings than in either the Moses Room or the Chamber. Moreover, there are more places for Peers in wheelchairs to listen to the proceedings in Committee Room 4A than there are in the Moses Room or, indeed, in the Chamber of this House. Therefore, at every level there is an advantage to being in Committee Room 4A and this added Motion will be of extra benefit to those who have mobility issues.
	Motion agreed.

Health: Non-communicable Diseases
	 — 
	Debate

Moved By Lord Crisp
	To call attention to the worldwide incidence of non-communicable diseases; and to move for papers.

Lord Crisp: My Lords, it is a privilege to open this debate on such an important issue, which sadly affects, or will affect, the lives of all Members of your Lordships' House, either directly or indirectly through family members. In talking about non-communicable diseases, I am talking about diabetes, cancer, cardiovascular disease, respiratory diseases and mental health. You may ask why I am drawing attention to this at this time, because these diseases have been with us for a long time. The reason is that this is a growing problem. It is now the biggest set of health issues globally and the fastest growing set of health issues in every continent, including those afflicted by HIV/AIDS. We are ill equipped to deal with them, and we need a new and concerted effort to confront them.
	When I put forward this proposal for a debate, I actually wrote, "To draw attention to the worldwide epidemic of non-communicable diseases". Somebody in the Table Office, quite rightly I guess, chose to change that to "incidence of non-communicable diseases", reasoning that an epidemic is something that is spread and communicated. In the ordinary sense of the word, however, we are dealing with an epidemic. As far as we know, these diseases are spread not by infection or biological process but they certainly are spread by social processes. Diet, the availability of food-healthy and unhealthy-smoking, alcohol, lack of exercise, stress and social pressures, which may in turn lead to overeating, alcohol, smoking and so on, are all key factors in the major spread of these diseases. They are sometimes called the diseases of affluence but, as I will say later, they also strike the poorest in the world.
	I am very grateful to the distinguished noble Lords who are taking part in this debate and I know that they are bringing great expertise and knowledge in the fields of mental health, diet, cancer and coronary heart disease. I am particularly delighted that my noble friend Lady Hayman is returning to speaking in the House. My task is to set the scene, identify some of the key strands and ask just a few questions of the Government. Let me start with the context of the diseases.
	I am not going to give your Lordships a lot of statistics but will try to limit myself to a few which scope and shape the problem. Now, 60 per cent of deaths in the world are due to these diseases-twice the number due to communicable diseases. This has changed markedly in recent years and is growing fast. While these diseases are associated with ageing, as they are with affluence, it is noticeable that a quarter of the deaths from them globally are in people under the age of 60. If we look at the UK, a quarter of the deaths from these diseases are in people under the age of 70. They are what we in the Department of Health and elsewhere would tend to call, or have called, preventable deaths. If I might take one example to show the pace of growth, diabetes is one of the fastest growing diseases and there are now 300 million people in the world affected by it. It is estimated that there will be 500 million by 2030. The numbers are vast: in India, it is 52 million people; here in the UK, it is something like 2.8 million people and growing fast. I believe that the noble Lord, Lord Kennedy, will have more to say on this.
	These diseases are often called diseases of affluence. Indeed, as societies develop more of these diseases become more prominent. In Europe, 85 per cent of deaths are now due to these diseases but they hit the poorest population in a society worst. If we think of those causal factors such as smoking, diet and so on, we can understand that. Globally, Africa is the fastest growing area for non-communicable diseases. This is not just about death. It is also about disability and dependency, and the long-term and economic impacts in both the treatment of these diseases and lost productivity. This has been authoritatively estimated as being of the value of $47 trillion over 20 years. One-third of that is in mental health and I am sure that my noble friend Lady Murphy will have more to say about that. What is also noticeable about those costs is that $7 trillion of them are in low and middle-income countries-in other words, it is disproportionately hitting their economies.
	I have already alluded to the fact that perhaps the most significant issue here is prevention. Up to 40 percent of cancers, 80 per cent of type 2 diabetes and much of heart disease and stroke are preventable or can be delayed to the advantage of both patients and of costs. I have already mentioned the causes which, again, your Lordships can see in one simple statistic: 7 per cent of UK hospital admissions are due to or related to alcohol, diet, exercise, smoking and, of course, obesity. I know that the noble Lord, Lord McColl, will be talking more about obesity and diet but in the UK 25 per cent of people are now in the category labelled as obese. In India-this may be much more surprising- 45 per cent of children in its cities are underweight and 25 per cent are overweight, so they are being affected by both aspects of the problem. I read an extraordinary story in the newspaper, perhaps reminding me that I should not always believe what I read there, that something like half of the Indian Cabinet has had gastric bands fitted-in other words, surgical devices to restrict the size of their stomach to prevent overeating.
	So we have here a picture of a set of diseases that are distinguished by applying to us all, rich and poor, in every country in the world. They are driven by social factors as well as others, require a massive focus on prevention and, crucially, cannot be handled in the same way as the diseases of the previous century. Diseases have changed since health systems were set up. Our systems in the UK, for example, based on hospitals and doctors, were set up largely around episodes of care coming in and being dealt with-being killed or cured, if you like-whereas another way of thinking about these non-communicable diseases is to talk of them being long-term conditions. Those conditions last, and we live with them, for many years. Over those years a typical patient will have some acute episodes where maybe they need to be in hospital, they will have a lot of self-care and they will get care from neighbours and social services as well as from health services. They need a completely different pattern of care from the ones that our systems deliver.
	The South African Minister of Health, Dr Aaron Motsoaledi, says that incentives in all our systems are in the wrong place. In talking about diabetes, he asks why we pay only a certain amount to the people who prevent diabetes, much more to the people who treat diabetes and the highest amount possible to those who deal with the complications of diabetes. We have a system that incentivises the highest level of treatment as opposed to one that incentivises prevention. I know that there are no simple answers, no one has the answers and the situation is changing all the time, but here is a real opportunity for global learning and working with others around the world on how to deal with this growing epidemic.
	This debate is timely. I was extremely fortunate to be successful in the ballot because two weeks ago, on 19 and 20 September, there was a UN summit on non-communicable diseases, which was attended by virtually every country in the world and 34 heads of state. This got very little reporting in the UK, which was understandable, given what else was going on at the time, including the economic situation, but I am pleased to have the opportunity with this debate to draw a little attention to this set of issues and to what happened at that summit.
	The summit was important; it was part of a process of the world, as it were, starting to agree what will replace the millennium development goals when they come to fruition in 2015. As noble Lords will know, those goals were set in 2000 for reducing deaths from TB, HIV/AIDS and malaria, as well as reducing child and maternal mortality. These are wholly admirable and there has been a lot of progress. We always need priorities. However, one of the negative impacts of priorities is that other things are deprioritised, and over these years we have seen that as more money has gone into communicable diseases and, rightly, into child and maternal care, systems and resources have moved to those areas at the cost of non-communicable diseases. We have seen systems broken up as priority has been given to those areas. In due course, we will need to move beyond the MDGs and think about global targets and priorities for non-communicable diseases. I suspect that over the next two or three years there will be other debates in your Lordships' House around these issues as the collective will moves towards some target-setting.
	The UN summit identified six strands of action. The first was that this is not purely a health problem; it is a problem for the whole of Government and society-industry, civil society and NGOs as well as health.
	The second area was about reducing risk factors and creating health-promoting environments. Of course a lot of this is about individual responsibility for what we eat and drink but there is a lot that can be done through regulation and nudging, through lateral thinking and creativity. To take one terribly simple example, it is about how we design our buildings. Somebody drew to my attention the other day that, in most of our schools, children now stay in the same classroom all day. I was used to a system where I moved from one classroom to another, sometimes quite considerable distances during the course of the day. That meant that, just through the act of being at school, children were doing a certain amount of exercise. The design of a lot of our public buildings and spaces is important.
	The second area is about reducing risk factors and creating health-promoting environments. The third is about national policies and systems. The fourth is about global collaboration on regulation, trade and development policies. The fifth is research and development, and the sixth is monitoring, evaluating and learning. The outcomes from that summit are that, by the end of 2012, the Secretary-General must report back to the United Nations Assembly on what is happening. This is starting to move.
	The UK has a proud record in development, with what was achieved under the previous Government and, indeed, during the current Government. I am a great admirer of the work of DfID and the priority that has been given to it by this Government. The UK played an enormous role in the development of the millennium development goals. It is globally influential and can play an enormous part in giving this new agenda the priority that it needs.
	The Minister knows that I am not, however, an admirer of the NHS Bill, in part because it does not put these long-term conditions and non-communicable diseases absolutely at the centre of priorities. If it had, integration of services would not be an add-on. We would see much closer integration of health and social care, and all the carers together. Nevertheless, there are many good policies in the UK on treating non-communicable diseases and dealing with this problem. I look forward to hearing the Minister say more about that.
	I have four questions and challenges for the Government if they are to play this leading role. The first is aimed more at DfID than the Minister's department, and I will understand if a reply comes later. There is a problem not just of prevention but of access to treatment. In Zambia, for example, 90 per cent of people with diabetes do not have access to insulin. This leads them to a major problem. The World Trade Organisation agreed in 2001 that, in the event of a public emergency, countries could apply for exemption to international patents relating to essential medicines so that they could be produced generically and, therefore, much more cheaply.
	In the run-up to this high-level summit, the EU and the US and the pharma-companies argued that this should apply to non-communicable diseases. What is the Government's position on this? What is the Government's policy on the use of these exemptions of essential medicines relating to real crises and public emergencies in low-income countries?
	The second question applies both to the UK and to the global situation. What do Her Majesty's Government believe is the role of industry in non-communicable diseases, specifically the food industry? It must be involved, but I note that it is being given quite a prominent position. How will self-regulation work and what evidence is there that self-regulation will have the desired effects? Thirdly, what are the Minister's views on the research that is required here, and how we can link together non-communicable and communicable diseases?
	Finally, I notice that DfID uses MDGs as a method for determining what funds are awarded. Given that people in DfID understand as well as I do that this is the coming epidemic, what will be their role in exercising greater flexibility on this issue, and paying more attention to these diseases in the future? I beg to move.

Lord McColl of Dulwich: My Lords, I thank the noble Lord, Lord Crisp, for introducing the debate. As he has indicated, I intend to speak only about the terrible epidemic of obesity. It is the worst epidemic to affect this country for 100 years. It is killing millions, costing billions and the cure is free: eat less.
	What a strange world. Half the world is dying of starvation; the other half is gorging itself to death. Obesity is a disease which wrecks the human body; it causes an enormous amount of distress, disease and suffering. In the United Kingdom there are over 2 million people suffering from diabetes as a result of obesity and a further 750,000 have diabetes but do not yet know it. So-called adult diabetes has reached epidemic proportions and now affects teenagers and young children. Parents seem to be unaware and unconcerned that their children are obese and there needs to be a great deal of education in this field.
	Sport, of course, is important, but green spaces and sports centres do not influence the physical activity of children. Social inequalities are no longer a major factor in obesity. All children are at risk, regardless of family income or postcode, as the noble Lord, Lord Crisp, mentioned. Obesity leads to inactivity rather than the other way round. Obesity comes first. Reducing the intake of calories, rather than physical activity, is the key to weight reduction. Most obesity starts before children go to school; Professor Terence Wilkin and Linda Voss, of the Peninsula Medical School, have done a lot of work on the subject and found that 90 per cent of excess weight in girls and over 70 per cent in boys is gained before the child ever gets to school.
	What else does obesity cause? The arteries become silted up with fatty material, called atheroma. As noble Lords know from their Greek studies, atheroma means porridge. It may be Greek porridge, but it is not Scottish porridge. It silts up the arteries and can cause heart attacks, strokes and blockage of the arteries of the leg, leading to amputation. Blindness is another result, as are high blood pressure and cancer. The excessive weight wears out the joints, so people need their knees and hips replaced. Obesity leads to cirrhosis. We always think of cirrhosis in terms of alcohol poisoning, but now the commonest cause seems to be obesity, so we have a big problem.
	An even greater problem with this epidemic is that politicians refuse to admit that the cause of obesity is overeating. The Minister stated in Question Time on 12 September that his reason for refusing to believe that overeating was the main cause was that he was following the advice of NICE. Indeed NICE stated that:
	"A person needs to be in 'energy balance' to maintain a healthy weight-that is, their energy intake (from food) should not exceed the energy expended through...exercise".
	This obsession that Ministers have had for some years that it is a balance between what you eat and how much you exercise is the crucial mistake. The real balance is between calorie intake and the total expenditure of energy in the body. We have to run miles to get rid of a pound of fat and, bearing in mind that as little as 25 per cent of the calories we eat go on exercise, where do the other 75 per cent go? They go on the numerous activities of the body over which we have no control. The heart beats several million times in a lifetime, the kidneys filter a vast quantity of blood-about 360 pints over 24 hours-and there are myriad other activities in other organs, such as the liver, pancreas, bones and the alimentary tract. Where do those who believe that the energy from food is all used up in exercise imagine the energy comes from to run the heart, the pancreas, the liver and so on? Perhaps they imagine they run on air-perhaps hot air.
	What could the Government do to encourage the food industry, canteens and restaurants to serve smaller portions of food? There is a company called Cook, which has 50 outlets and prepares meals of the right size-meat, two vegetables and gravy. They are cooked, frozen and then stored. They can be heated in five minutes, giving an instant meal of the right size, the right quality and the right price.
	During the war, we had no obese people. We had the right quantity of food and the right kind of food. The only people who were obese were those who used the black market, and we children used to point our accusing fingers at them. Surely most mothers who are making their babies and children obese do not realise the terrible damage that they are doing, condemning them to a life of hardship, suffering and early death.
	Bearing in mind that most obese people cannot exercise because they are so overweight, all they have to do to lose weight is eat less. The noble Lord, Lord Soulsby of Swaffham Prior, has given me permission to tell your Lordships the following story. As you know, he cannot exercise because he is confined to a wheelchair, but he decided to take three stone of weight off. He used a really revolutionary technique: he took three stone of weight off by eating less. There are no mysteries, only mysterious people.
	Telling obese people that they have got to exercise is demoralising because they cannot. Most of them realise that it is nonsense to say so. What hope is there of dealing with this very serious epidemic if Ministers deny its cause? Exercise is of course very important-it is ideal for the functioning of the heart and control of cholesterol, and it gives one a sense of proportion and well-being-but it does not deal with the obesity epidemic. Of course I recognise that it is not the job of politicians to tell people how to live their lives, but it is surely the duty of government to speak the truth and give a lead. By continuing to stress that exercise is the answer, politicians are misleading the public.
	The message is absolutely clear: this is the most serious epidemic to affect this country for 100 years; it is killing millions and costing billions; it will wreck the NHS for sure. The answer is simply to eat less. When obese people reduce their weight, then they can begin to exercise to keep fit-but not to solve the obesity epidemic.
	I have been to see the director of NICE to reason with him, and he has now admitted that its advice is wrong. I have also been to see the Chief Medical Officer, and she has admitted that the advice is wrong. So the Minister is out on a limb. When will he listen to the Chief Medical Officer and NICE?

Lord Kennedy of Southwark: My Lords, I congratulate the noble Lord, Lord Crisp, on putting down this Motion for debate today. He has had a distinguished career in health and related fields, culminating in serving as the chief executive of the NHS and Permanent Secretary at the Department of Health. It is a timely Motion that allows us to reflect on the four major chronic non-communicable diseases and the enormous problems and suffering that they cause. I agree wholeheartedly with the thrust of the points that the noble Lord has made.
	The four major non-communicable diseases are, of course, cardiovascular disease, type 2 diabetes, cancers and chronic lung disease. As the noble Lord, Lord Crisp, said, 6 per cent of deaths in the world is a truly shocking statistic. I will speak briefly today about type 2 diabetes.
	For many years I felt stressed, agitated, tired and run down at work. You could say that if you work for the Labour Party for 20 years, what do you expect? But in reality, I was an undiagnosed diabetic, having symptoms and developing complications but not getting the treatment that my body desperately needed. The point made by the noble Lord, Lord Crisp, about how we have an about-face, with more money going into dealing with the complications than the prevention, is absolutely right. I hope the noble Earl can address that in particular in his response.
	Undiagnosed diabetics are an even more at-risk group. Enabling people to spot the signs, have a proper test, and seek medical care at as early a stage as possible, thereby offsetting some of the complications that can develop, is important for us all. Annual eye screening, regular checks on feet, and regular visits to a diabetes nurse are all welcome measures to deal with complications and enable sufferers to deal with the problems. They enable people with the condition to have a better quality of life and save the NHS considerable sums of money in treating otherwise preventable complications.
	Complications such as heart problems, strokes, amputations and blindness are all things that we can work together to eliminate and to improve people's quality of life. I am sure the noble Earl, in his response, will tell the House how much better prevention is than cure for sufferers of type 2 diabetes. Bearing in mind the huge number of preventable amputations that are still taking place today, something must be done to improve on this situation.
	I am delighted that my noble friend Lord Collins will respond to the debate for the Opposition. Like me he has type 2 diabetes. In our previous lives, mine as the director of finance for the Labour Party, and that of the noble Lord, Lord Collins, as general- secretary, we worked and sat closely together. Having been diagnosed some time earlier, I saw the signs in my noble friend and was not surprised when he told me the diagnosis from his GP. Getting the diagnosis, advice and treatment has certainly considerably improved how I feel and enabled me to take positive steps to control the condition.
	Soon after I was diagnosed, I joined Diabetes UK. I am sorry that my noble friend Baroness Young of Old Scone, who is the chief executive of Diabetes UK, cannot be with us today. She is at a board meeting, or otherwise would be taking part in this debate in your Lordships' House. Diabetes UK is a great charity and has given me great advice, help and support.
	I want to say congratulations and well done to Diabetes UK for winning the healthcare and medical research award at the charity awards this year for its diabetes roadshow, which goes out into communities to make people aware of the risk they are at. Through its campaigning and briefings, the research that it is funding, and the awareness and support that it gives, working with the Health Department, it is leading the way in ensuring that people can live fulfilling lives and avoid the problems and complications that diabetes can bring. Diabetes UK also has a fantastic care line, the only dedicated helpline in the UK, which enables sufferers to get advice and guidance when they need it.
	I also pay tribute to another diabetes charity, Silver Star, which my right honourable friend, Keith Vaz, the Member for Leicester East, was instrumental in setting up. It raises awareness of diabetes and its complications, particularly in the Asian community, both in this country and on the Indian subcontinent. Diabetes is one of the conditions where prevention is the key. Proper information is needed to allow people to make informed choices about their lifestyle. Better diet, losing weight, and more exercise all contribute to dealing with what has become an epidemic across the globe but that can be avoided.
	Again, I thank the noble Lord, Lord Crisp, for initiating the debate and look forward to the response by the noble Earl.

Lord Roberts of Llandudno: I thank the noble Lord, Lord Crisp, for introducing such a revealing and fascinating debate. I think I will need a consultation with my noble friend, Lord McFall, very soon.
	At the meeting in New York in September, just a week or two ago, the interesting thing was that 192 countries were represented there. There were 30 world leaders and 100 Ministers, who all came because they thought this was such an important subject. Is it not great that we are able to have international consultations that bring in the most vulnerable countries as well as those who have the most ability and knowledge? Anything that hinders international discussion and co-operation is very unwelcome. We support all these international efforts and must continue to do so. Many people from the UK attended that event. I was interested to read that not only were representatives present to discuss the four main areas but that discussions covered many other areas that affect many people. The noble Lords, Lord McColl and Lord Kennedy, referred to those areas. Diabetes can lead to blindness, for example, so there was representation from organisations representing blind people. Palliative care bodies, Catholic medical missionaries, Help the Aged, the Alcohol Policy Alliance and neurologists were also represented. These areas all touch on the core of non-communicable illnesses that we are discussing. We have heard these described as western diseases. However, as the third world develops, these diseases are becoming more prevalent there, although in Africa diseases such as AIDS still cause the most concern.
	The risk factors in the UK comprise tobacco consumption, excessive alcohol consumption, an unhealthy diet and a lack of physical activity. As has been said, these factors cause poverty, disability and death. However, they can be regulated, even though we often have battles with those who benefit from the sale of alcohol or tobacco. We need to find a balance. Perhaps we do not want to return to the prohibition era in the United States, but how far should regulation go? Drink is sold not only in one part of my local supermarket but in several parts. How can we regulate that? Binge drinking can result from such practices. Are we too sensitive and nervous about regulating alcohol?
	I declare an interest as a teetotaller. Perhaps I should not be speaking in this debate. People say that drinking is acceptable as a social activity, but in many cases it is harmful, especially when it involves excessive alcohol consumption. We are engaged in a battle over tobacco sales and displays and warnings on cigarette packets. However, these industries provide employment. Do Parliament and the Government have an adequate dialogue with these people? They might respond more positively if we could discuss the problem with them in a different manner. There are still problems to be tackled. Once problems are tackled, you see a great change. My grandfather on my father's side was a quarryman in Blaenau Ffestiniog. He and many of his friends died from silicosis and pneumoconiosis, as I note when looking at cemeteries in the Conwy valley. These diseases are caused by inhaling quarry dust and mining dust, but they can be prevented.
	People have mentioned the need to monitor the content of food and the availability of various fitness opportunities. The forthcoming Olympic Games and Paralympic Games provide an opportunity to encourage and engender enthusiasm for keeping fit among people of all ages. They could increase participation in physical activity. However, we have not only a responsibility to ourselves as individuals but a responsibility to provide role models and examples to other countries to enable them to avoid making the mistakes that we have made in the past. The relationship between poverty, deprivation and ill health can be seen very clearly.
	We have raised standards and improved lives and life expectancy. In Swaziland the life expectancy is 31.8 years and in Japan 82.6. So much could be done, and I am delighted-and I will stand by it all the way-that our overseas aid budget is not to be tampered with and that we will, I hope, reach 1.7 per cent of GDP for overseas aid during the lifetime of this Parliament. I can assure noble Lords that we on these Benches at least will not consider any diminution of that particular part of our budget.
	I am a past chairman of Wales Water Lifeline. We were on the border of Iraq and Iran during the war there, and the children just wanted safe drinking water. That was all they wanted. There was also a high death toll in Rwanda due to unsafe drinking water. As I think I have said before in the House, Wales Water Lifeline provided water-purification plants and well digging in these places when cholera, diarrhoea and so on were rampant. One morning a fax came telling us that we had stopped cholera dead in our patch because of safe drinking water. That was wonderful.
	I used to say, although I am not sure whether it is true or not, that if we could stop the manufacture of armaments just for two weeks, the money saved could provide pure piped drinking water for every family in the world. Is there a way of doing it? I am an eternal optimist and I would like to think that, if only we could take the measures that have been outlined by others that I have touched upon in an inexpert way, we could in our lifetime halve many of the deaths caused by preventable diseases in the world today.
	I thank the noble Lord, Lord Crisp, for introducing this debate.

Baroness Masham of Ilton: My Lords, I thank my noble friend Lord Crisp for bringing up this most important topic today in your Lordships' House. He is an important ambassador, taking expert knowledge to the World Health Organisation and the United Nations and bringing information back to the UK. This is a timely debate for your Lordships as we will be debating the Health and Social Care Bill next week and non-communicable diseases need to be highlighted. They are a huge part of the health agenda.
	My husband, who was a Member of your Lordships' House and for a time Deputy Chief Whip, sustained several non-communicable diseases. He had several strokes, diabetes, Parkinson's disease and a cancer tumour of his lower bowel. After 10 years of living with these conditions, he died of a respiratory disease-pneumonia-in an A&E department on a Sunday evening. My father died of coronary heart disease on a Sunday morning in Scotland when I was 18. The locum doctor thought he had a chest infection. He died half an hour later. Perhaps your Lordships will understand why I am so passionate to see correct diagnoses, care facilities improved, and the prevention of and research into the hundreds of different NCDs high on the agendas of countries across the world. In the mean time, however, the correct drugs should be available to help with the different diseases.
	The UK, as a so-called developed country, has many improvements to make. Many people who watched the recent "Panorama" programme on the treatment of vulnerable people living in a care home near Bristol are still reeling from the horror of what they saw. Many people are surprised to learn that care assistants can get a job with no registration. They can be nurses who have been dismissed for dangerous and disgraceful practices and then be taken on as care assistants with no registration and no control. Surely all patients with non-communicable diseases who are vulnerable should feel safe and protected. I hope that the Government will take the safety of all patients very seriously. There have been far too many unkind and unacceptable incidents in recent years. That just cannot go on.
	The Global Status Report on Noncommunicable Diseases 2010states:
	"Noncommunicable diseases (NCDs) are the leading global causes of death, causing more deaths than all other causes combined, and they strike hardest at the world's low- and middle-income populations. These diseases have reached epidemic proportions, yet they could be significantly reduced, with millions of lives saved and untold suffering avoided, through reduction of their risk factors, early detection and timely treatments".
	The Global Status Report on Noncommunicable Diseases is the first worldwide report. It shows ways to map the epidemic, reduce its major risk factors and strengthen healthcare for people who already suffer from NCDs.
	It is important that the World Health Organisation gets support from Governments worldwide. Of the 57 million global deaths in 2008, 36 million-or 63 per cent-were due to non-communicable diseases, principally cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. As the impact of NCDs increases, and as populations age, annual NCD deaths are projected to continue to rise worldwide. Accurate data from countries are vital to reverse the global rise in deaths and disabilities. At the high-level UN meeting this September, world leaders unanimously adopted the political declaration on non-communicable diseases, agreeing that the global burden and threat of NCDs continues to be one of the major challenges for development in the 21st century, undermining social and economic development throughout the world. The director-general of the World Health Organisation, Dr Margaret Chan, told the meeting that NCDs are,
	"the diseases that break the bank".
	Recommendation No. 6 is of the utmost importance. It is to:
	"Recognize the urgent need for greater measures at global, regional and national levels to prevent and control non-communicable diseases in order to contribute to the full realization of the right of everyone to the highest attainable standard of physical and mental health".
	There are thousands of non-communicable diseases across the world, but there seem to be clusters in different parts of the country in the UK. Two such conditions are spina bifida and leukaemia. Why should that be? There is a vital need for ongoing increased research into all non-communicable diseases. The health department, universities, pharmaceutical bodies, specialised units of experts and voluntary associations should all be working together to address the multitude of needs.
	Diabetes has become a serious global emergency. The epidemic is now imposing a heavy dual burden of infections and non-communicable diseases on already under-resourced health systems. To date, no country has succeeded in turning around the figures. There are 50.8 million people with diabetes in India and 92.4 million in China. Africa will have the highest percentage increase in the number of people with diabetes over the next 20 years; 80 per cent of people with diabetes in Africa are undiagnosed. It is encouraging that countries are working together to try to find ways to stem that ever-increasing problem.
	The Neurological Alliance is the collective voice of 80 brain and spine charities, representing the 8 million people in England with a neurological condition. They are often called the neglected 8 million. I hope that the Minister will see that every person diagnosed with a neurological condition has access to high-quality, joined-up services and good information.
	Being a member of the all-party group on cancer and rarer cancers, I must make your Lordships aware of the great concern that exists about late diagnoses, especially of rarer cancers. The Government must be congratulated on setting up the rarer cancer fund, but research from the fund on the diagnosis of rarer cancers revealed that GPs are failing to diagnose almost a third of people with rarer forms of cancer at an early stage, damaging their chances of long-term survival. Late diagnosis is the major reason why cancer survival rates in England lag behind those in other developed countries. GPs should be rewarded for identifying the signs and symptoms of cancer when they are at an early stage and for referring patients for investigation; they should not be encouraged to delay referrals, which seems to be a worrying trend. I hope that the Minister will help over this serious matter.
	I hope that the specialist voluntary associations which bring members' needs to the Government's and the public's attention, and which lobby for better conditions, will be listened to. I have experienced at first hand with my husband's condition the value of specialist nurses when they are involved in the treatment of patients. They support patients with conditions such as diabetes, strokes, Parkinson's disease, MS, rarer cancers, and so many others. Not having specialist care would downgrade treatment and care.
	Many improvements can be made for adults and children with non-communicable diseases here in the UK. I refer to services such as wheelchairs and prosthetics. Assessments of patients and the supply of aids and equipment can take months, if not years. Someone with a condition such as motor neurone disease needs help immediately. Sometimes patients languish in hospitals far longer than necessary due to the inefficiency of the system.
	I end by asking the Minister whether he is satisfied with the training of doctors in pain control for thousands of patients with non-communicable diseases, such as arthritis, when pain can interfere with employment and the quality of life. Is it not the case that several pain clinics have had to close down for lack of funds? I hope that this debate will highlight some of the needs of people living with non-communicable diseases.

Baroness Hayman: My Lords, I have a double reason to be grateful to the noble Lord, Lord Crisp, for his introduction of today's debate. Not only is it timely and important, it gives me the perfect justification for reversing my intention of keeping a dignified silence in your Lordships' House until 2012. Instead, I shall use the opportunity of today's debate to make my first speech after leaving office as Lord Speaker. This is also my first speech from the Cross Benches. In my 15 years in your Lordships' House I have led a peripatetic life. I have spoken from the Front and the Back Benches, and from the opposition and government Benches. I fear that there is nowhere left for me to go. I look across to the Bishops' Bench but the obstacles to that are many and insuperable, so I will probably have to stay where I am.
	The reason why I feel justified in abandoning that intention of not speaking is because today's debate chimes with so many of my interests-past and present. For four years I was the founder chair of Cancer Research UK. Having the privilege to do that made me aware of the burden of non-communicable diseases in the UK, particularly cancer, but also the growing threat and damage that those diseases cause in middle-income countries. The issue has already been raised today of their being in a way diseases of growing affluence. One needs look only at the increase in the incidence of lung cancer in China with the increase of smoking there. The noble Lord, Lord McColl, made us very aware of the dangers of diet leading to ill health in those major non-communicable diseases. It is important to recognise the role of public health in countries that are developing their health systems-public health in terms of surveillance, of education and of prevention.
	There are often debates on whether health interventions in the developing world should be in terms of programmes or systems but, when DfID is looking at investment, the knowledge that we have gained in this country in terms of public health systems-based very much on having a comprehensive and truly national NHS-is an important gift that we can share with other countries. Another past interest as trustee of the Tropical Health and Education Trust also made me aware that it is not a one-way street when we talk about exchanging knowledge and healthcare professionals and practices with other countries. There is much that we can learn from the developing world in attitudes to medical problems and innovation. You need only look at the recent reports of how technology is being used in Tanzania to transfer by mobile phone the bus fare needed to women who have obstetric fistula. For them the problem is not the cost of the operation, because that is provided through charitable support to hospitals in that country; their problem is not having the bus fare to access that treatment. The innovations in technology being used through mobile phone networks can at a stroke end that problem. In that and many other areas there are possibilities to learn from other countries.
	I should declare not a past interest but the only responsibility that I have taken on since leaving office in your Lordships' House, which is as a trustee of the Sabin Vaccine Institute in the United States. That institute has as its mission:
	"To reduce needless human suffering from infectious and neglected tropical diseases through innovative vaccine research and development; and to advocate for improved access to vaccines and essential medicines for citizens around the globe".
	Some noble Lords will have noticed that word "infectious" and perhaps considered that in another place I might be out of order because the debate introduced by the noble Lord, Lord Crisp, is about non-communicable diseases. I shall return to that in a moment because there are links between NCDs and NTDs that need to be explored.
	Neglected tropical diseases are a tremendous scourge of the world's poor. They are diseases of poverty. Of the bottom billion-the 1.4 billion people in the world who exist on less than $1.25 a day-virtually every man, woman and child will be afflicted by one or more of the seven most common neglected tropical diseases. These diseases have been disabling, disfiguring and blinding their victims for centuries. They have enormously debilitating effects on individuals and economies because they cause a lack of growth and well-being, not only for the patient but for the nation concerned. That is an important point to make to follow on from the noble Lord, Lord Roberts of Llandudno, in the argument about investment in overseas aid. At a time of global economic crisis, we need those middle and lower-income countries to be growing their economies, not for them to be ravaged by the effects of the diseases that make many of their citizens unable to contribute economically.
	I said that I would deal a little with this interaction between communicable and non-communicable diseases. In many ways, neglected tropical diseases behave like chronic non-communicable diseases. They are chronic; their clinical manifestation-the weakening of the immune system and the resulting long-term disability-is very much the pattern of non-communicable disease. They have the same effects and therefore it is important that we recognise the interactions between them and the fact that those interactions are not only in the parallels that I have made but are in co-morbidities and often in the neglected tropical disease being the catalyst for the non-communicable disease.
	There are many examples. Schistosomiasis is one of the areas in which the Sabin Institute is working on the production of a vaccine. We also know that urinary schistosomiasis is a leading cause of bladder cancer in Africa and the Middle East. Significant numbers of cases of anaemia are because of hookworm infections, and liver flukes account for a number of cancers. That connection is there and my plea today is that we do not only look at vertical programmes of health but look at the health systems that we are supporting in the developing world; and at the interaction of the sorts of social factors that have already been described, and of the communicable and the non-communicable diseases, in our attempt to end the scourge and the pain and suffering that are caused worldwide.

Lord Rea: My Lords, I congratulate the noble Baroness on returning to the Benches; she has shown that it will be greatly beneficial to all of us by the quality of the speech that she has just given. I would also very much like to congratulate the noble Lord, Lord Crisp, on securing this debate so soon after the recent high-level conference on NCDs that we have been talking about. If your Lordships will forgive me, I am going to use the abbreviation for brevity and to save tongue-twisting.
	This topic has been growing in importance for more than 50 years, since communicable diseases came more under control. NCDs are now the major public health problem of the developed world. More recently, as the noble Lord, Lord Crisp, has pointed out, there has been a major increase in these diseases in the developing world, where they now cause around 60 per cent of deaths, which in total numbers greatly exceed NCD deaths in developed countries because of their greater populations. A higher proportion of these deaths in developing countries occur in people under 60 than in the developed world. The rapid increase of NCDs in the developing world was the main stimulus for the UN conference two weeks ago.
	I come to this debate from a background in UK general practice but with a particular interest in public health. This was triggered by a three-year stint working with children in Nigeria where I came face to face with the importance of the environment and particularly nutrition in giving rise to childhood disease and high mortality-of course, in that case from communicable disease. I declare an interest as current chairman of the all-party Associate Parliamentary Food and Health Forum and as a trustee of the respected National Heart Forum, an NGO that brings together more than 50 organisations with an interest in the prevention of heart disease. Because the risk factors which lead to cardiovascular disease are very similar to those underlying most NCDs-smoking, faulty diet and lack of exercise-the National Heart Forum has recently widened its remit to embrace NCDs other than heart disease. It has published numerous reports, tool-kits and interactive programmes to help NCD prevention activities throughout the world, and two members of the National Heart Forum team were delegates at the New York conference.
	NCDs are age-related diseases; they are degenerative in nature, but they do not affect everyone. Some people and populations develop these diseases much earlier than others. Some of these differences are due to increased genetic susceptibility; for instance, people of South Asian origin are particularly prone to diabetes and heart disease and those of West African origin are more likely to have high blood pressure when exposed to the typical Western diet of high salt, sugar and saturated fat. The external risk factors that favour their development are well known, as many noble Lords have pointed out, and affect many more people than the genetic causes. As has also been pointed out, these can be reduced or eliminated-in other words, these diseases are largely preventable.
	Apart from the basic three risk factors I mentioned earlier-physical inactivity, faulty nutrition and smoking-other conditions that result from these factors are themselves risk factors; for example, as well described by the noble Lord, Lord McColl, obesity results from a combination of faulty diet with, to a lesser extent, lack of exercise. Obesity is a risk factor for some forms of cancer and particularly for type 2 diabetes, which often leads to cardiovascular, kidney and other diseases; high blood pressure can lead to stroke and heart disease. In the developed world, mortality rates from NCDs have come down considerably, partly through preventive measures, particularly tobacco control legislation, but also because it is now possible to palliate and control many of these conditions, though not to cure them, because of their degenerative nature. So we are left with many if not most of our older citizens, including quite a high proportion of your Lordships' House, on some form of medication or living with a prosthetic limb or organ. This is very expensive and a major reason why the costs of the National Health Service continue to escalate.
	In the past, heart attacks and stroke-or apoplexy, as it was known-were the preserve of the well fed and wealthy: but not any more-in fact the reverse is the case. The better off and better educated you are, the less likely you are to suffer from an NCD. If you do, it will hit you later in life than those at the other end of the social scale. They provide a prime example of health inequality.
	This is even more the case in low and middle-income countries where diabetes and its complications are probably the most common form of NCD. There, the costs of treatment are borne mainly by sufferers themselves or their families as state health budgets are meagre. NCDs are therefore important contributors to poverty, as well as vice versa, and have a major economic impact. The reasons for the rapid escalation of these diseases in the developing world are well encapsulated in the words of Jean Claude Mbanya, the new Cameroonian president of the International Diabetes Federation. He said:
	"We have moved away from our traditional cultures towards a Western lifestyle associated with prosperity. It is good, but it brings a trend to be more sedentary, not eat the right foods, not exercise enough, and to drink and smoke more".
	The political declaration agreed by the UN summit two weeks ago describes the problem with impressive thoroughness as well as the action needed in its 65 paragraphs and 36 sub-paragraphs. It correctly concentrates on prevention, emphasising the need for a comprehensive approach and, as the noble Lord, Lord Crisp, said, the need to create "equitable health-promoting environments". It draws attention to the WHO's framework convention on tobacco control, its global strategies on diet, on physical activity and health, and on reducing the harmful use of alcohol and its recommendations on the marketing of foods and non-alcoholic beverages to children. To my mind, its main benefit is that it flags up the importance of NCDs and puts them firmly on the international agenda. What I regret is that it does not come up with any suggested targets to stimulate action, such as the millennium development goals. That is put off to a future date. Some of the action suggested could well be taken to heart by our own Government-of course, some of it is. For instance, paragraph 43(f) includes the words:
	"Research shows that food advertising to children is extensive, that a significant amount of the marketing is for foods with a high content of fat, sugar or salt and that television advertising influences children's food preferences, purchase requests and consumption patterns".
	That research was carried out in this country by Professor Gerard Hastings at the request of the Food Standards Agency.
	Another paragraph suggests that Governments should:
	"Promote ... interventions to reduce salt, sugar and saturated fats, and eliminate industrially produced trans-fats in foods, including through discouraging the production and marketing of foods that contribute to unhealthy diet".
	Unfortunately, under pressure from industry, it does not mention how these interventions are to be made. Long experience in public health, backed by research, shows that voluntary agreements with industry or commerce to act in this way are usually ineffective. But our Secretary of State, Andrew Lansley, appears sincerely to believe that bringing industry on board through Responsibility Deals is the way to do it. This is a course of action that one delegate likened rudely to "letting Dracula advise on blood bank security".

Lord May of Oxford: My Lords, I join with others in expressing my appreciation to the noble Lord, Lord Crisp, for initiating this debate, which, as others have noted, is very timely. I also think that I can confidently speak for the Cross-Benchers collectively in saying how warmly we welcome the noble Baroness, Lady Hayman, to our ranks. We are honoured and delighted to have her.
	Five years ago I had the privilege of giving the opening address of the international meeting on parasitology. In that, I joined with others in emphasising the need for communicable diseases to go beyond their then focus on the big three-tuberculosis, HIV and malaria-to move on to the neglected communicable diseases of poorer countries; that is, diseases of poverty. There has been welcome progress in that area.
	As this debate reminds us, the fact remains that roughly two-thirds of annual deaths today come from non-communicable diseases, 80 per cent of which are in poorer or middle-income countries-that is, four in five deaths. The recent high-level summit is the UN's first meeting on non-communicable diseases. Perhaps more interestingly, it is only the second meeting it has ever had on diseases, the first being several years ago on HIV.
	The meeting emphasised many of the complexities and issues. There is no question that non-communicable diseases are a big problem in poorer countries but just how big they are is not quite so clear. For one thing, the number of deaths from NCDs, which is emphasised by the World Health Organisation and many earlier speakers, tells only part of the story. Perhaps more relevant is the age at which disease strikes, the morbidity or mortality. Whether they are communicable or non-communicable is a more important statistic. When one looks at that statistic, the fact remains that communicable infectious diseases, especially HIV/AIDS in sub-Saharan Africa, remain the biggest burden in most poorer countries.
	Several speakers parsed the word epidemic. To talk of an epidemic of NCDs clouds the fact that the rise in such deaths derives more from demographic changes- from populations increasing and people living longer-than from other factors, such as obesity and smoking, important though they are. Fifty years ago, the average life expectancy on this planet of a child born was 46 years. Today, it is a little more than 64 years. We cannot relate intuitively to the notion that average life expectancy is 46 years because half a century ago the gap between the developed and the developing world in life expectancy was 26 years, whereas today it has shrunk to a still disgraceful 12 years.
	In this time, that shrinking simply means more older people, which means more deaths from NCDs. Projecting the trends we have today into the future is not easy. In a moment I will express some rather harsh opinions on the outcome of the summit, but one of the useful things that it did-at least, I hope it has-was to call for better monitoring and better data collection, which is welcome and appropriate.
	Despite all these complexities and uncertainties, many people have pointed out some of the effective and important things that we could and should be doing to diminish the surge of non-communicable diseases in poorer countries. For one thing, the noble Baroness, Lady Masham, called for more research on NCDs. As a researcher, I would never fail to endorse a call for more research. One of the interesting facts about NCDs is that essentially all biomedical research is on diseases of the rich. A rough estimate is that some 90 per cent is on non-communicable diseases. The good thing is that as a result we have many drugs that are both cheap and effective against some NCDs. Particularly for heart problems, statins and aspirin have made a big difference in the developed world and are little used in the developing world. That is one opportunity.
	We have heard some good and important facts about risk factors and what can be achieved by banning smoking in work and eating places. Taking such successes from the developed world into the developing world is not easy. In the lobbying that preceded this meeting, it was distressing to find tobacco lobbies from the developing world opposing implementation of the sorts of things that, despite their protests, we have managed slowly and haltingly to implement here. The active promotion by elements of the food industry of eating habits that lead to obesity-and thus increase the incidence of NCDs such as diabetes, heart problems and the things we have heard about-is already proving a rather intractable problem in the developed world. The noble Lord, Lord Crisp, was right in expressing some satisfaction in the good examples that we have set and our proud record of helping not just ourselves but others, but even in our own country encouraging self-regulation of the food industry is simply not working.
	I amplify some of the good remarks made by previous speakers, particularly the noble Lord, Lord McColl. There is an authoritative recent book by a chap called David Kessler, who was the head of the United States Food and Drug Administration-the FDA-and dean of the medical school at Yale. It is rather a gloomy book with an upbeat title, The End of Overeating. I recommend it. With forensic precision, it documents some of the ways that the high levels of salt, fat and sugar in processed foods have come about and the consequent damaging effects on health, and even suggests that, like smoking, there are elements of addiction in some of these additives. It also documents how the attempts to address this problem are opposed by skilled lobbies, using many of the techniques and indeed some of the organisations that battled against regulating smoking.
	Coming back to the UN summit, I will read a brief account of what went on before it convened from the journal Science:
	"The game plan was for diplomats to craft a political declaration that their leaders would endorse in New York City, spelling out the extent of the problem and concrete actions".
	It goes on to say that what has emerged is,
	"a watered-down document that is long on talk and conspicuously short on actions, with little guidance on who should do what to combat NCDs".
	It then goes on to say that, leading up to the meeting, the World Health Organisation identified four priorities, as we have heard: cancer, diabetes, cardiovascular disease and respiratory disease. It continues:
	"The report also named four major risk factors: smoking, unhealthy diet, lack of physical activity, and alcohol abuse. Health advocacy groups called for the world's governments to address them by ... committing to targets such as reducing salt consumption or instituting tobacco taxes by a certain date ... But a leaked 5 August draft of the declaration showed other interests getting in the way. According to sources who saw",
	it, including,
	"editors at The Lancet, the British Medical Journal",
	and others, the successive modification shows how any,
	"solid commitments were 'systematically deleted, diluted and downgraded'",
	by the developed countries, including our people. It goes on:
	"They were replaced with 'vague intentions to "consider" and "work towards"'".
	In summary-I will read so as not to make it more verbose-we certainly need to move beyond the encouraging successes in the campaign against the big three infectious diseases and the promising extensions to other neglected diseases of the poor. We must include action against the incidence of avoidable deaths from non-communicable infections in the developing world. As others have emphasised, international summits and aid are important. Ultimately, it will devolve to national Governments.

Lord Kakkar: My Lords, I, too, join noble Lords in congratulating the noble Lord, Lord Crisp, on securing this important debate so soon after the United Nations summit on the problem of non-communicable diseases. In making my contribution, I remind noble Lords of my declarations of interest as professor of surgery at University College London and director of the Thrombosis Research Institute in London. Both institutions have active research programmes globally in the area of cardiovascular disease, the non-communicable disease that I will concentrate on.
	As we have heard, non-communicable diseases now account for 63 per cent of all deaths-of the 57 million people who died in 2008. By 2020, some 52 million individuals around the world will die of non-communicable diseases. In 2008, some 25 per cent of the 57 million deaths were due to two important cardiovascular disorders: stroke and coronary artery disease.
	We are making excellent progress in our own country in the management of patients with coronary artery disease and stroke. The national strategy addresses the 3 million of our citizens who suffer from cardiovascular disorders. That burden of disease was associated in 2006 with some 50,000 premature deaths in our country. It is estimated that by 2020 cardiovascular disease in the United Kingdom will be associated with some 58,000 premature deaths. Annually in our country, prescriptions for circulatory disorders cost the National Health Service some £2 billion. The total economic burden of direct and indirect costs associated with the management of cardiovascular disease in our country is estimated at some £30 billion a year. In the United States of America, the direct and indirect costs associated with the management of cardiovascular disorders come to some $400 billion a year.
	It is in the developing world, in low and middle-income countries, that we see the fastest growth in cardiovascular disorders, one of the most important of all non-communicable diseases. Twice as many people in low and middle-income countries die of cardiovascular disease than they do of tuberculosis, HIV/AIDS and malaria combined. We can recognise the risk factors associated with the development of cardiovascular disorders in these developing countries. They are very similar to the risk factors that have been identified in our own population. High blood pressure, high cholesterol, lack of physical exercise, abdominal obesity, smoking and inappropriate diet are all important risk factors that can be recognised in these developing populations. As the noble Lord, Lord May, said, longevity ensures that populations are living longer in these countries, so they start experiencing cardiovascular disease.
	The pattern of cardiovascular disease in low and middle-income countries appears to be quite different from the patterns seen in western countries. As we have heard, the onset of this disease is at a younger age in populations in India, in China, in Africa and in other important nations around the world. The pattern of disease in coronary artery disease, for instance, anatomically seems to be quite different, with disease more distally distributed in blood vessels, making it less amenable to the interventions that we provide for our patients successfully to treat coronary artery disease underlying coronary disease before it presents as a heart attack.
	Of course, in addition to the pattern of disease and the early onset of disease, we also recognise in low and middle-income countries that the risk factors that are seen to be associated with the development of coronary artery disease are also associated with poverty in those countries. The high burden of cardiovascular disease in those countries is associated with increasing poverty in those populations.
	If we look at the report by the World Economic Forum presented as part of the United Nations summit, we see that for low and middle-income countries over the period 2011 to 2025-a 14-year period-the economic loss to those communities associated with non-communicable diseases accounts for $7 trillion of lost economic output; for cardiovascular diseases it is some $3.76 trillion over that same 14-year period. That has huge impact in those nations in terms of avoidable economic burden.
	If we look at this in terms of individuals, it is estimated that across Brazil, China, India, South Africa and Mexico, 21 million years of productive life are lost annually due to cardiovascular disease, a disease that is often attributed, as we have heard, to lifestyle choices, and of course to other environmental factors, but that is in many circumstances avoidable.
	In driving economic benefit, therefore, there are important opportunities to be derived from targeting cardiovascular disorders and trying to promote strategies for prevention. Important public health strategies might be adopted around the world that could help reduce the risk of cardiovascular disease and its burden both for the individual and for society. Many of the strategies that have formed part of our national frameworks for targeting cardiovascular disease in the United Kingdom could usefully be adopted elsewhere in the world. We have heard during this important debate about the importance of prospectively collecting data to understand the distribution of risk factors for cardiovascular disease in low and middle-income countries, and in so doing better target our interventions that drive prevention on a population basis.
	There are also some very exciting novel approaches to the prevention of cardiovascular disease at a population and an individual level. One of them is the concept of the polypill-identifying large populations and offering them; a pill that combines elements such as the statin that we have heard about from the noble Lord, Lord May of Oxford; aspirin, an agent that inhibits the activation of the blood cells in the circulation that come together to form small blood clots in the coronary arteries or the blood supply to the brain that result ultimately in a hard attack or stroke; an agent to drop blood pressure; and medications to control blood sugar. This polypill offered to populations, it is suggested, will reduce the impact of risk factors for the development of cardiovascular disease and therefore reduce the burden of that disease both clinically and, eventually, economically.
	Another important approach is to target nutrition during pregnancy and in early life because it is well recognised that poor nutrition during pregnancy and in the first few weeks, months and years of life is associated with a heightened risk later in life for high blood pressure and the development of heart disease.
	A third approach, which my own research institute is involved in, is the concept of vaccinating against atheroma, the disease pathology that was mentioned by the noble Lord, Lord McColl. The narrowing of the arteries is considered to be multifactorial, and there is some suggestion that an immunological response to the vessel wall as a result of chronic infection might play an important role in its pathogenesis, so vaccination across populations might be an alternative strategy to the prevention of cardiovascular disease. These are all novel ideas, with research being undertaken at many institutions here in the United Kingdom.
	The research, whether conducted here and directed to populations elsewhere in the world, or conducted elsewhere in the world and directed to populations in our own country, is hugely important, because the burden of cardiovascular disease is a true global problem. In this regard, I ask the Minister what proportion of National Institute of Health research funding is directed towards the important problem of cardiovascular disease, both in improving the management for those with established disease and in the strategies targeted at risk identification and the development of biomarkers to understand better those at high lifetime risk for the development of cardiovascular disorders.
	What proportion of our overseas aid budget is directed towards promoting research into cardiovascular disorders in low and middle-income countries? Potentially understanding the disease better in those nations, and therefore helping to prevent or treat it more effectively, could offer substantial economic benefits to those countries-benefits that are derived from such appropriate prevention and treatment of cardiovascular disease being directed to more beneficial areas of economic development.
	Finally, I turn to the potential of using the Commonwealth-there was in your Lordships' House some weeks ago a very interesting debate on the ongoing role of the Commonwealth-to develop a network between our own country and those with whom we have strong emotional and economic ties to pursue research into this important, chronic, non-communicable disease to determine whether that would both help us serve the people of those nations and ensure that nations on whom our own economic growth in the future is going to be dependent through export could avoid the economic and medical toll of cardiovascular disease.

Baroness Murphy: My Lords, I add my voice of thanks to the noble Lord, Lord Crisp, for securing this debate and for the opportunity that it gives us to talk about the scourge of these five chronic diseases. This is also an opportunity for me to express my personal admiration for his commitment in recent years to the cause of improving global healthcare through the improvement of the education of healthcare workers in developing countries. I wish all strength to his arm in that area.
	Before I go on to talk about mental health-which will be no surprise to anybody because everyone knows that that is what I do-on behalf of the well-rounded of this world I want to pick up on something that the noble Lord, Lord McColl, said. He is absolutely right that the obese should eat less and that we should all eat less-that is a message that comes over strongly-but I should like to point out that an obese individual losing weight permanently by eating less is as likely as a heroin addict coming off heroin. It is almost impossible. We must go back to the comments of the noble Lord, Lord May: we need population solutions; we need to support people to eat less; and we will need to tackle the food industry to do so. I am sure that the noble Lord, Lord McColl, will forgive me but it is an issue which is so easy to say but so difficult for many people to follow.
	As we have heard, the World Economic Forum, which through the Harvard School of Public Health did the research on the anticipated costs of these five chronic diseases, found that mental health will account for one-third of the overall $47 trillion. I am not sure that I can take on board what a trillion is, but a huge amount of money-about one-third of the anticipated costs that NCDs pose-will be lost due to the dependence of people with mental health problems. As a result, countries and economies are losing people in their most productive years. About 70 per cent of lost economic output is due to mental illness and heart disease alone. That means that it is the largest burden of disease globally, measured by disability-adjusted life years; there is a greater economic toll globally from mental disorders than from any of the other major disorders. I suppose that that is not surprising, as the human brain is the seat of all higher intellectual, emotional and cognitive functions, which are essential for individuals to fulfil their fullest potential. Many of these disorders begin in childhood and adolescence-a critical period of life when an individual is being educated, establishing effective social relationships and laying the ground for a successful career.
	Even in the least developed regions, where infectious diseases are prominent and still important sources of disorder and disability, mental and neuro-psychiatric disorders remain and are a growing source of disability. Suicide claims the lives of 800,000 people annually. That is clearly a gross underestimate; the way in which we collect suicide statistics is very poor. Over 90 per cent of the 24 million people suffering from schizophrenia reside in low and middle-income countries, and less than half those 24 million receive any treatment, even in developed countries. Some of the treatments available in near neighbours such as eastern European countries are pretty frightening. There are still some profound human rights abuses in some of our neighbouring and many developing countries, akin to the sorts of treatments that were available here in the medieval period. They are still happening in many countries. Countless millions of mentally ill people go untreated, suffer misery and poverty and, quite often, grave human rights abuses.
	The World Economic Forum research was published just a fortnight before the UN meeting on non-communicable diseases, which was billed as a once-in-a-generation opportunity to tackle the predicted wave of the diseases. I cannot but express my disappointment that mental health was scarcely given a mention. It was not on the agenda and the final communiqué had three and a half passing mentions of it. Our Government were urged to promote mental health at this meeting but did not do so. How are we to get the countries of the world to take it seriously if our Government do not?
	We can guess why these disorders were ignored. The problems of stigma, the rejection of mental health patients and the denial of how economically important they are, are all too frequent. But of course there are unique challenges associated with mental disorders because of the cultural influences in the manifestation of illness, the stigma which attaches to family and healthcare workers as well as patients, and pervasive misunderstandings about causes and appropriate treatments. Most diseases have straightforward diagnostic systems that are relatively impervious to the influence of culture and context, but mental disorders are hampered by shifting and imprecise diagnostic systems, a weak evidence base for their causality and a lack of awareness and resources for appropriate assessment. The treatment facilities for mental disorders are generally segregated from those for other health problems. That is a problem that goes back to the way in which European colonialists often viewed these disorders in the past two centuries and has resulted in very fragmented funding streams, haphazard training and care pathways. In many countries, the system of care is based around a single large, rare specialist facility, often in an old mental hospital-maybe one per country in an urban centre-which provides for a tiny fragment of the country's mentally ill and separates people from the care of the community where patients and families live. There is a need for decentralisation of services to scale up access to treatment and care. We now have evidence-based knowledge of very effective treatments and delivery systems that can be adapted to meet the needs of different cultures.
	This morning I was talking to Professor Martin Prince, who is Professor of Epidemiological Psychiatry at the Centre for Global Mental Health at the Institute of Psychiatry. I asked whether he could give me some up-to-date good examples of where some new cost-effective delivery systems were in place. He particularly wanted me to mention two excellent services. One is in Goa and is being delivered by community mental health workers, picking up antenatal depression across large numbers of people in the community. I understand that the cost of treatment there is less than the cost of a loaf of bread a day, so it is extremely cost-effective. There is another one around Rawalpindi in Pakistan, where a system of community mental health workers provides basic community mental healthcare across a very wide area on an algorithm that reaches a primary care physician for those where the provision of community mental health workers is uncertain. Again, that is extremely cost-effective, and it is very well researched to show how effective it is in bringing sustained benefit over a number of years. There are many examples such as those.
	To echo the point made by the noble Baroness, Lady Hayman, we have a lot to learn from some of the systems that have been put in place. There are some very cost-effective, economical and simple ways in which to pick people up and treat them early, using people trained with specific tools over short periods of time. Nevertheless, these are isolated good examples that I can quote-there is an enormous gap-and the time for global action has come.
	Sadly, while we know that mental health is integral to achieving social, economical and health goals of development, it continues to get short shrift. It needs to be included explicitly and independently as a key component of discussions and recommendations. The World Federation for Mental Health has set up a convention of working groups to aid the United Nations in developing guidelines, goals, tasks and outcome measures-all those United Nations phrases which I suspect sometimes do not lead to much action. However, we have to start somewhere. There is much good work going on and it deserves government support.
	Finally, can the Minister explain why the Government, whom I will praise for having done so much to foster mental health as a priority at home, have not given a vigorous lead at the United Nations? I understand that this particular meeting wanted to get some action on smoking, diet and exercise-particularly smoking-and that there was some hard stuff to be done. I understand the importance of that, but it does rather play into the hands of the ignorant, stigmatising mental health yet again by denying its crucial importance to suffering and national economies. What plans do the Government have for putting right that neglect of mental health on an international stage? It is really one of those disorders that we cannot stand by and ignore.

Lord Collins of Highbury: My Lords, I, too, congratulate the noble Lord, Lord Crisp, on initiating this debate. I have huge respect for the work that he has done and continues to do in promoting better health here, and globally, through his experience of the National Health Service, his involvement as a fellow of the Institute for Healthcare Improvement and, above all, his leadership on global health. In his book, Turning the World Upside Down, the noble Lord highlights the most striking thing about health in the 21st century which is, he says, the way the world,
	"is now so interconnected and so interdependent. This interdependence is changing the way we see health, creating a new global perspective and will affect the way we need to act".
	As we have heard, the UN conference has set out plans to tackle non-communicable diseases such as diabetes and heart disease, which now pose a greater global burden than infectious diseases. As has been said in this debate, lifestyle-related diseases are now the leading cause of death worldwide, killing 36 million people a year. Much of that toll, as we have heard, is in low and middle-income countries and that is where efforts must be focused.
	However, as we have also heard, Europe today has a high prevalence of non-communicable diseases, such as cancer, diabetes, cardiovascular diseases, obesity disorders and musculoskeletal disorders, which together cause 86 per cent of deaths in the EU. According to the EU, the causes of these diseases can be attributed to the interaction of various genetic, environmental and, especially, lifestyle factors-including smoking, alcohol abuse, unhealthy diets and physical inactivity. Linked by these common risk factors, many of these diseases are, as we have heard, preventable. Spreading access to effective treatment more evenly across the EU would bring significant health and economic benefits to all EU countries.
	At this point in my contribution, I feel I must declare an interest; in fact, I should say interests. When I read the WHO report on this subject, I realised that I was very much a victim of my own bad lifestyle. Five years ago, I stopped smoking and subsequently put on weight. As the noble Lord, Lord McColl, has said, I think that I ate too much. I then took on a very stressful job, as my noble friend Lord Kennedy said, as general secretary of the Labour Party. I discovered soon after taking that job that I had high blood pressure. As a result of further tests, I was told that I had very high cholesterol levels and to cap it all-my noble friend Lord Kennedy has already outed me in this respect-I was formally diagnosed as a type 2 diabetic. Early diagnosis and the excellent response of the NHS means that I have a chance of avoiding the worst consequences of these diseases, but would it not have been better if I could have avoided them in the first place? Early preventive action not only saves lives, it also saves money.
	This is where I also want to amplify the conclusions we have heard from the WHO report, which focused on affordable actions that all Governments should take. First, as we have heard, there should be measures that target the population as a whole such as high taxes on tobacco and alcohol, and smoke-free indoor workplaces and public places, as well as campaigns, more importantly, to reduce salt and dangerous fats. I very much understood some of the comments about some agencies that are trying to stop us making progress in this area. Secondly, there should be other actions focusing on individuals such as screening and early treatment, which I have already mentioned in my own case. As I said in my maiden speech to this House, the personal is the political. It was the smoking ban that prompted me to stop smoking, while my local swimming pool provides an excellent service enabling me to deal with some of the stressful elements of my life-I go swimming every morning-and that screening led to my early treatment for diabetes. These are the factors that influenced my health. Unfortunately, no one yet has found a cure for my addiction to chocolate but maybe that will come.
	A telling fact for me in the WHO report, as the noble Lord, Lord Crisp, said, is that the total cost for adopting these strategies in all low and middle-income countries would be £7.2 billion a year. In comparison, the cumulative costs of heart disease, chronic respiratory diseases, cancer and diabetes in poorer countries are expected to top £4.4 trillion between 2011 and 2025-an average of nearly £316 billion a year-according to the World Economic Forum. Many countries have already adopted the public health interventions that have seen marked reductions in disease incidence and mortality. The WHO monitored the progress of 38 countries taking steps to address cardiovascular disease at both population and individual levels over the space of a decade. All recorded substantial decreases in exposure to the risk incidence of disease and death toll; proof, if we ever needed it, that there are affordable steps which all Governments can take to address non-communicable diseases.
	It is also a fact, as we have heard, that men and women in low-income countries are around three times more likely to die of non-communicable diseases before the age of 60 than they are in high-income countries. In the 2008-2013 EU health programme, the main activities focus on raising public awareness, improving knowledge and reinforcing preventive measures. To support these actions, it proposes networks and information systems across member states to generate a flow of information along with analysis and exchange of best practice in the public health field. As the noble Lord, Lord Crisp, has said, we need to promote a strong global approach involving integrated action on risk factors combined with the efforts to strengthen health systems towards improved prevention and control. I therefore urge the Minister to support positive intervention on this important global health issue and, as the noble Lord, Lord May, said, to have action-not just words.

Earl Howe: My Lords, I thank the noble Lord, Lord Crisp, for introducing a debate on an issue of such global importance. Indeed, I am grateful to all noble Lords who have spoken so powerfully and I welcome in particular the noble Lord, Lord Collins of Highbury, to his Front-Bench responsibilities. Non-communicable diseases, or NCDs, kill millions of people across the world every year. Indeed, they are responsible for three in five of all deaths and bring illness and disability to countless more. People with NCDs are high users of health services worldwide. In England alone, around 70p in every £1 spent on health and care is spent caring for people with a long-term condition, the majority of which are as a consequence of the so-called four big killers: cancer, cardiovascular disease, chronic lung diseases and diabetes.
	I listened with huge interest to the noble Baroness, Lady Hayman, and I am so glad that she gave way to temptation by joining our debate today. To pick up on what she said, non-communicable and communicable diseases combined can devastate both the lives of individuals and hinder the growth of whole countries. This is particularly the case in developing nations, which face the double burden of communicable and non-communicable diseases. The true prevalence of non-communicable diseases is often hidden in a number of countries, simply due to the lack of data. I shall come on to that in a moment.
	The noble Baroness, Lady Masham, is right: the scale of the challenge is huge but it is not insurmountable. We start from a position of collective international commitment to act. The UK, along with other Commonwealth countries, has called for global action. The recent UN high-level meeting about NCDs, which a number of noble Lords referred to, raised awareness of the issue and culminated in a unanimous declaration by all member states stating their commitment to taking concerted action to prevent, manage and treat NCDs. There is a helpful practical focus on tackling the common risk factors and the WHO has introduced the idea of "best buys" that can be introduced by all countries at little cost.
	My right honourable friend the Secretary of State for Health participated fully in that meeting. I take note of the disappointment expressed by the noble Lord, Lord May, but at the same time the meeting was an important first step and a sound basis for sustained action in the years and decades to come.
	In reply to the noble Baroness, Lady Murphy, I say that mental health is referred to in the political declaration and the UK supported this inclusion, but we wanted to ensure support for the primary focus to be on tackling the common underlying risk factors and wider social and environmental determinants for the four big killers. We do not in the least underestimate the burden of mental ill health. I hope that the mental health strategy is evidence of that, but we believe that, once we see benefits from this initial focus, there will be positive impacts on health and well-being far beyond these four disease groups, including mental health. The linkages in risk factors were highlighted in the UN declaration.
	Global health has long been a priority for the UK Government. I can tell the noble Baronesses, Lady Masham and Lady Hayman, that we are trying, working through both the Department of Health and the Department for International Development, to help developing countries to build health systems that can meet today's challenges, including the problem of NCDs but also all causes of ill health, especially for the poorest in society.
	The UK also supports multilateral organisations. We are the third largest donor to the World Health Organization and we support initiatives such as the Global Alliance for Vaccines and Immunisations, GAVI, to which the UK is the largest contributor. Indeed, GAVI has immunised over 250 million children against hepatitis B and saved over 3 million lives as a result. I was interested in the work of the noble Baroness, Lady Hayman, in promoting vaccine uptake in the third world.
	Whatever we do, though, I fear that we need to face one unpalatable fact: we will not be able to eradicate NCDs, unlike smallpox. There is no obesity inoculation. Prevention alone, important though it is, cannot be the sole answer either at home or abroad. Globally, we continue to work to strengthen health systems so that they can provide early, cost-effective care to all who need it, including the poor and vulnerable.
	I mentioned that we are strengthening the capacity of countries to deliver improved health services. This is a key area of DfID's work. So, too, is the health partnership scheme, which facilitates links between UK health institutions and professionals from developing countries to improve health outcomes by sharing skills and capacity building. We are also supporting the medical training initiative, designed for doctors from developing countries to benefit from training in the NHS and foster exchange programmes. I pick up the point made by the noble Baroness, Lady Hayman, that we can learn from others overseas.
	I can tell the noble Lord, Lord Crisp, that we also support research on global health. For example, DfID has recently launched PRIME, which stands for "programme for improving mental health care". That is a new multinational research programme that will focus on the development, acceptability and impact of mental health care packages for priority mental disorders. We have also supported research on tobacco, and I can let the noble Lord have further details on those programmes if he is interested.
	The noble Lord asked me about access to essential medicines. This is a priority for us. We are supporting countries to develop domestic health financing mechanisms to ensure sustainable and long-term funding for cost-effective interventions to tackle NCDs, not just drugs but diagnostics and vaccines as well.
	Health services have a key part to play in reducing health inequalities in terms of access and quality and working with others to improve health outcomes. We need health systems not simply to treat disease but to be reoriented towards preventative action. As ever, as the noble Lords, Lord Crisp and Lord Kennedy, reminded us, prevention is better than cure-preventing the onset of disease rather than merely treating the symptoms.
	Our health reforms in the UK are designed to strengthen our approach to improving public health. On the Health and Social Care Bill we will debate how there is a new health improvement duty for local authorities, supported by a ring-fenced public health budget. This will allow local decisions on health improvement to be taken about the interventions that are most suited to local needs. We think that that will represent a very responsive system, more so than we have at the moment. We are committed to reducing health inequalities, which is why for the first time, subject to parliamentary approval, we are putting into legislation a duty on the Secretary of State for Health focused on the need to reduce inequalities. That makes this the strongest health inequalities duty we have ever had.
	First and foremost in the UK, we focus on prevention through an integrated approach as the major non-communicable diseases share a number of common risk factors. We address the causes of the causes, the underlying wider social and environmental determinants. The conditions in which people are born, grow, work and age, their education, employment and housing-all these shape the health of individuals and communities. The Public Health Cabinet Sub-Committee, which we established, allows a wide range of Cabinet Ministers to agree how best to respond to the public health challenges. The importance of taking a whole-of-Government approach is emphasised in the UN political declaration.
	We are a world leader on collecting data on public health, and other countries draw on our approach to surveillance. WHO is looking now to strengthen global monitoring of the prevalence of NCDs and the common risk factors, which is essential if we are to establish the kind of meaningful targets referred to by the noble Lord, Lord Rea. In England we are putting in place a new strategic outcomes framework for public health at national and local levels-again, in an effort to benchmark these matters-which will be based on the evidence of where the biggest challenges are for health and well-being.
	On the domestic front, we are making progress on some of the key areas of action highlighted by the UN and we stand ready to share those experiences with others. NCDs share common risk factors-tobacco use, unhealthy diets, physical inactivity and alcohol misuse. Our actions, particularly on tobacco control and reducing salt intake, have been highlighted by WHO as international best practice.
	The noble Lords, Lord Rea, Lord May and Lord Collins, rightly lay particular emphasis on tobacco policy. The UK strongly supports the WHO Framework Convention on Tobacco Control, and we take it very seriously. Tobacco use is by far the biggest risk factor for NCDs, so effective policies to reduce smoking rates are essential. We urge all countries that are not yet parties to the treaty to sign up to it as quickly as possible, and equally we urge all those who are signatories to implement the treaty fully, as we have done in this country. The convention encourages parties to take comprehensive action on tobacco control. The Tobacco Control Plan for England, published in March, sets out a range of actions that will bear down on tobacco use.
	The noble Lord, Lord Collins, mentioned salt. As he knows, we have made considerable progress in recent years by working in partnership with industry and others to reduce salt intake. It has gone down by about 10 per cent in the past few years, which has served to prevent over 4,000 deaths a year and saved the NHS a great deal of money. We are taking that work forward as one of the pledges contained within the Public Health Responsibility Deal.
	As well as these initiatives, which aim to tackle population health here in England, we are working to strengthen our primary care system, putting the patient and their GP at the heart of service delivery. This will reduce the impact of non-communicable diseases through programmes like the NHS Health Check, which I hope is of particular interest to the noble Lords, Lord Kennedy and Lord Collins. Our NHS Health Check programme assesses people's risk of heart disease, stroke, diabetes and kidney disease. It has the potential to prevent 1,600 heart attacks and strokes a year-so I am told-to prevent over 4,000 people a year from developing diabetes and to detect at least 20,000 cases of diabetes or kidney disease earlier. It is an important programme.
	The noble Lord, Lord Crisp, asked me about the training and the DfID programme. He suggested that DfID was too rigid on this, and too focused on NGOs. Health system strengthening includes training as a key part of DfID's work. Globally, we provide training through a number of different organisations, including government organisations, NGOs and our contributions to multilateral organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. DfID estimates that 25 per cent of its aid to health supports human resources including training.
	The noble Baroness, Lady Hayman, spoke about neglected tropical diseases. I am pleased to tell her that, only yesterday, the UK announced that we would support the final push to eradicate guinea worm from the world. My honourable friend Stephen O'Brien yesterday issued a challenge: we will increase our support to guinea worm eradication and fill up to one-third of the financing gap, provided that others step forward and fill the other two-thirds. This funding would form a vital part of the push from former US President Jimmy Carter to ensure that guinea worm is consigned to the history books alongside smallpox. We have already committed £25 million over five years to tackle schistosomiasis, or bilharzia.
	The noble Lords, Lord Crisp and Lord Rea, and my noble friend Lord McColl expressed doubts about engagement with the food industry in this country. We start with the recognition that people's lifestyle choices are affecting their health. The Government cannot address this challenge alone through central, top-down diktat. Everyone has a part to play, not just government but also business, industry, retailers, the third sector and individuals themselves. The Responsibility Deal is not a substitute for the development of government policy on public health; it complements it. We also know that businesses can reach consumers and deliver information in ways that other organisations, including government organisations, cannot.
	My noble friend Lord McColl spoke very powerfully on obesity. I would like to think that he and I are not so far apart as he perhaps indicated. We are clear that the Government cannot tackle obesity alone. It is an issue for society as a whole. We all have a role to play. We will shortly be publishing our plans for how obesity will be tackled in the new public health and NHS systems in England, and the role of key partners. I could not help feeling, listening to my noble friend, that we might be talking at cross purposes. There is surely a distinction between keeping healthy people healthy-and the advice that goes with that-and helping obese people become less unhealthy. For the latter group, my noble friend's advice is surely spot on. The NICE advice, I suggest, is relevant and accurate for the former group. Diet has an important role, and we are indeed working to improve it, reducing the consumption of fat, sugar and excess calories. However, it is not tenable to suggest that physical activity is not important. I wonder whether my noble friend and I can agree that physical activity helps to balance the energy consumed. I look forward to a little conversation with him about that afterwards.
	The noble Lord, Lord Roberts of Llandudno, spoke extremely convincingly about alcohol. Retailers, producers and pubs ought to promote, name, market and sell their products in a responsible way. We need to see leadership from them to produce a radical and better balance between business interests and social harm. I am encouraged to tell him that there has been a wide sign-up to the first set of collective pledges under the Responsibility Deal. Networks are already developing the next tranche of pledges. Again, by working closely with industry, we help it to shoulder its responsibilities and can go further and faster in developing the initiatives that we all want.
	The noble Lords, Lord Kennedy and Lord Collins, referred quite rightly to diabetes. Our national diabetes service framework, begun in 2003, has been reinvigorated this year by a new NICE quality standard for diabetes against which future care will be measured. Our national diabetic retinopathy screening programme has been offered to 98 per cent of people with diabetes; that is a great record. A National Health Check programme for 40 to 74 year-olds in England includes an assessment for those at risk of developing type 2 diabetes as well as cardiovascular and kidney disease. That programme has real potential to indentify people at risk of diabetes early and prevent its debilitating complications.
	Now, I have a few apologies; first, to the noble Baroness, Lady Masham, who asked me about the training of doctors for pain control. I do not have information on that in front of me, but I will certainly write to her. I shall also write to the noble Lord, Lord Kakkar, who asked me about the proportion of NIHR funding on cardiovascular disease and any research network that there may be on that disease in the Commonwealth. He also asked me about UK funding for research on cardiovascular disease in developing countries, and I can tell him that the Indian Council for Medical Research is collaborating on several research topics related to NCDs; indeed, there is a collaborative research programme in Mumbai studying the impact of nutrition in pregnancy and early childhood on the risk of heart disease in later life, and its intergenerational effects.
	I hope that what I have said will reassure the House that we are taking action on all fronts to prevent and manage NCDs both nationally and globally. However, concerted action is needed across Governments and industry to meet the challenges of NCDs. The human and economic consequences of inaction are too grave for us all to do anything else.

Lord Crisp: My Lords, I said at the beginning that it was a privilege to introduce the debate, and it has certainly been a privilege to listen to it and to hear the wisdom, insights and wide range of interests of the noble Lords who have spoken. I think that we have all learnt something; I certainly have. It has been very good to have insights from the patients' perspective as well as from clinicians and everybody else.
	This will be a continuing theme. The UN summit to which we have all referred was described as the end of the beginning. Non-communicable diseases will now be a major global theme of those sorts of global meetings. In due course, we will no doubt start to see some targets being set. For the time being, however, I beg leave to withdraw the Motion.
	Motion withdrawn.

Building Stability Overseas Strategy
	 — 
	Debate

Moved By Baroness Falkner of Margravine
	To call attention to the Building Stability Overseas Strategy; and to move for papers.

Baroness Falkner of Margravine: My Lords, nearly 50 years ago, John F Kennedy spoke a simple truth:
	"The basic problems facing the world today are not susceptible to a military solution".
	He was speaking in the context of the Vietnam War. Since then, the United Kingdom has deployed its forces in the Falklands, Kuwait, Bosnia, Kosovo, Sierra Leone, Afghanistan and Iraq. In this century, we have seen the continuation of conflict in Iraq, Afghanistan and, recently, Libya.
	It is right that I start this debate by paying tribute to our men and women in uniform who do so much to defend our country's interests. However, we should also note with relief that we live in a significantly safer world. Inter-state war has declined considerably since the end of the Second World War. It is estimated that 29 million people died in declared wars in the previous century. Civilian deaths caused by despotic Governments were on an even more horrifying scale. The Soviet Union and China alone account for nearly a million deaths. Joseph Stalin found that:
	"The death of one man is a tragedy. The death of millions is a statistic".
	For us, that comment represented a collective failure of our humanity.
	In recent years, civil wars, too, have become less numerous and less dangerous. According to the World Bank's world development report, there were 21 active major civil wars in 1991-92, but since then the figure has steadily fallen to less than 10 each year since 2002. Thankfully, the toll of battle deaths has also diminished. In 1988 there were more than 200,000 deaths per year, whereas in 2008, there were some 50,000. In the post-World War 2 settlement it has been the creation of institutions that has most powerfully militated against conflict.
	Despite the rise in sovereign states from around 50 to nearly 200, the United Nations, the Bretton Woods institutions and the international judicial system have worked to diminish the violent resolution of disputes. The international community has succeeded in building institutions to cover the three essential characteristics for maintaining international order: an overarching body to maintain peace and security; a legal settlement system to adjudicate disputes; and an enforcement mechanism to carry out the will of the community should all else fail.
	However, there are still too many states within the international system which lack the resilient frameworks that might safeguard against violence, hence the continuation of conflict. In fragile states, the Government are often illegitimate or weak, the rule of law absent and public institutions are at best ineffective or at worst partisan. To this mixture add poverty, ethnic, religious or ideological strife and chronic underdevelopment. When conflict breaks out, its spillover has consequences for all other countries in the region too, with the internally displaced and many millions of refugees in other countries.
	Conflict's costs are borne disproportionately by women. A recent assessment shows that 80 per cent of those displaced are women and children. Some 75 per cent of the world's refugees are hosted by neighbouring states, with consequent destabilisation there, too. It is in this context that we can think about how a middle-sized European power such as ours can achieve the security of its citizens, as well as play a significant role in reducing the fallout from violent conflict for others.
	We have started in the right place, with our commitment to reaching 0.7 per cent of GNI in development assistance. Committing resources to others at a time of austerity at home is a difficult argument to put to the public, but it is the right one. It is incumbent on the Government to find the most effective mixture of soft, smart and hard power that Building Stability can exploit. I am enthusiastic about this strategy's focus. It is predicated on a simple hypothesis: to work early on identifying areas of risk and, where we can, to work upstream to prevent conflict and maintain stability. Once a crisis has broken out, for whatever reasons, we should use our diplomatic and other resources for a rapid response to ameliorate the situation.
	The strategy seems to hint at another important element: that of staying the course for the longer term. Too often when a crisis occurs, the attention span of both policy-makers and the public is too short. A classic example of this is Afghanistan in the late 1980s, where, once the mujaheddin had repulsed the Russians, our attention turned elsewhere. Civil war took hold, 4 million refugees became Pakistan's problem, while Afghanistan was seized by the Taliban and hosted al-Qaeda, with the subsequent war which has cost lives and treasure.
	The World Bank's research shows that recurring civil wars have become a dominant form of armed conflict in the world today. Every civil war that has begun since 2003 was a resumption of a previous civil war: 90 per cent of conflicts initiated in this century were in countries that had already had a civil war. Peace is often not enduring: fighting has also continued after several recent political settlements, as we have seen in Afghanistan and the Democratic Republic of Congo.
	With that in mind, let me turn to the work of the stabilisation unit which is the engine room for this strategy. Will the Minister assure me that while the strategic defence and security review, which establishes the roof under which the unit sits, is due to be reviewed or renewed every five years, the ongoing programme work of the stabilisation unit will have a longer horizon? Building stability is a long-term venture, which cannot be picked up and put down according to the vagaries of five-year electoral cycles. Partners tend to have little confidence in our staying the course with them if we are subject to changes in priorities every few years.
	Sound analysis is also key to the effectiveness of the strategy. Above all, conflict is predicated on a failure to resolve political differences peaceably, whatever the root causes behind the political situations. As a former foreign affairs analyst, I know only too well that crises come in two forms: they often blow up where you could see them coming, but were powerless to change things; or they blow up in places where, if you had anticipated them, you could have done something at an earlier stage. Improved intelligence and horizon scanning will no doubt improve our capabilities, but I want to know more about what criteria we would use to decide the level of our involvement.
	Let me use the Middle East as an example. It seemed that in our desire to engage with the regime in Bahrain, we mistook assurances of reform for substance. As these assurances evaporated like the morning mist-if only they had been as pure-we have been wrong-footed. In Syria, as in Libya, our previous Government courted regimes that are and have always been-there are no surprises here-every bit as venal as history had predicted. If our future analytical capabilities are to be more robust, which I hope they will be, I hope the Minister will take away the thought that henceforth our political and diplomatic priorities should be based on a longer-term strategic framework of alliances than those of the previous Government.
	This brings me to the criteria for deciding which crises to respond to and how. I accept that in most cases this will depend on how much we can achieve multilaterally and bilaterally, and the extent to which our own interests are engaged. However, the lesson here must be that we need to lay the ground for multilateral action upstream, working with those who are willing at an earlier stage, in a preventive mode. It is in this area that the civilian stabilisation group can be most effective.
	This pool of personnel with expertise in institution building, economic recovery, security sector reform and other practical state-building roles is commendable and I applaud its success in support of the National Transitional Council in Libya. However, one gets the impression that it is more of a reactive force than a preventive resource. I would argue that if it were to shift its focus to more preventive work, it would provide the skills and training for peacemaking and crisis management later in the day. Turning to skills and training, are the members of this group to be given regular skills updates and capability upgrades to keep them at the top of their game? Deployment is often too late to serve as a good training ground. Will resources be dedicated to this role specifically?
	I also want to highlight the importance for the strategy's success of recognising the role of women. I acknowledge the references to United Nations Security Council Resolution 1325 and attempts to improve a gender focus. However what is missing is a practical appreciation of how to mainstream gender. Women's active and meaningful participation must be central to all post-conflict and peacebuilding processes. For example, the use of stabilisation response teams should acknowledge that at least one member of the SRT should have the knowledge and skills to address sexual and gender-based violence.
	At a more strategic level, the BSOS steering board could take a proactive decision to promote government co-ordination in longer-term thinking about gender impacts on decisions. In Afghanistan, a decision was taken to draw down our commitment by the next election, a decision which I fear will not be conducive to stability. In the political calculations, was any effort made to think through the impact on Afghan women, who I fear will be hung out to dry in a Taliban-ruled Government of the future?
	In Libya, where we have leverage here and now, what steps are we taking to encourage the National Transitional Council to work with women towards a new political settlement? Can the Minister tell us whether talks have been held with the group Women4Libya to see whether we can assist its campaign for rights? Can he also assure us that our generous support for UN Women will continue and that we will work with that organisation to ensure that UNSCR 1325 is given practical effect?
	I welcome the strategy for its attempts to improve the effectiveness of our efforts and to redefine our priorities in the period ahead. I am the first to applaud a "whole of government approach", as it is only when we pool our ample talent and our still-considerable resources that we can deliver best. My final concern, therefore, is one of accountability. When we have complex structures which are pulled together but remain autonomous, it becomes difficult to see where decision-making lies or where change can be effected. I would ask that one of the three contributing departments assumes overall responsibility for the strategy. We are talking here of work which will expend potentially billions of pounds, yet we cannot be sure whether we need to go to the FCO, the MoD or DfID for detailed scrutiny. My own preference would be for a named Minister to take ownership of the strategy-for a clear letter box to be identified and accounted for. I am delighted to see my noble friend representing the FCO in answering this debate, and I would be entirely happy for the FCO to be the lead department, but I am pragmatic in this regard as long as we have that accountability in a named Minister.
	I am grateful for the opportunity to debate stability beyond our shores. In closing, let me recall to my noble friend the Minister the words of a Conservative Prime Minister, Benjamin Disraeli, who said:
	"War is never a solution; it is an aggravation".
	Let us hope in this House that we can redouble our efforts to avert it.

Lord Black of Brentwood: My Lords, I warmly welcome the publication of the Building Stability Overseas Strategy and congratulate my noble friend Lady Falkner on securing such an early and, I hope, comprehensive debate.
	We have seen in very sharp focus in recent years the consequences of societal breakdown in too many countries. It must be right to address this crucial issue and to do so, as this paper does, by drawing together expertise from across government and across disciplines.
	I have always set great store by the axiom that prevention is better than cure, which in this field means that we should try to build stable and cohesive democracies before trouble strikes, rather than picking up the pieces afterwards. While the paper has an admirable amount to say about rapid response and the handling of crises once they have become established, I want to concentrate on what it describes as "upstream prevention", which in the words of the strategy means,
	"helping to build strong, legitimate institutions and robust societies ... that are capable of managing tensions and shocks so there is a lower likelihood of instability and conflict".
	This paper sets out with great clarity the building blocks of that process. Society must respect human rights and the rule of law. Governments must win the consent of their populations, and political systems must have broad-based public legitimacy.
	The "web of institutions", in the paper's phrase, that provide the basis of trust and confidence-the police, the legal systems, the banks, religious and civil society groups- must function effectively. Political systems must be accountable and everyone should have a voice. All sectors of society-the paper highlights women in particular, as well as young people and diverse ethnic groups-must feel that they are part of society's "warp and weft". Corruption and bad governance need to be rooted out. The strategy document rightly points to a range of states, including Somalia, Zimbabwe and Burma, where corruption is rife and is a breeding ground for conflict. And then, of course, most crucial of all, is the question of economic growth. The strategy document highlights how that is an essential part of the glue sticking stable societies together.
	Central to the achievement of all of these laudable aims is, in my view, the role in a stable society of a free and independent media. I should like to talk a little about that today and, in doing so, declare an interest as chairman of the Commonwealth Press Union Media Trust and executive director of the Telegraph Media Group.
	The one slightly disappointing aspect of this otherwise excellent strategy is that it does not cover this issue, and the positive role that free independent media-print, radio and broadcast-can play, more centrally. There is, to be fair, some mention of it. The BBC World Service is highlighted, along with the excellent work of the British Council, as an example of how "soft power" can be deployed in building stronger societies. The media are also cited as being among the institutions that can help cement together riven societies. But their role is far more central and far more essential than that. The strategy sets out how:
	"The most peaceful political systems are accountable, giving everyone a voice and trusted to manage difference and accommodate change".
	It adds that where elections take place,
	"losers must have a clear stake in the future of their country and sufficient trust in the system to believe they are not permanently excluded from power".
	That is absolutely right. But what more effective way is there to secure this than through a vibrant and diverse media which can tackle at their heart that sense of exclusiveness which fosters instability? This is particularly true, as the paper highlights, among women.
	The example of what has been achieved in Ghana is highly pertinent, where a move towards democracy could not have been achieved without a move towards a free and diverse media, particularly radio, which is the main medium for communication. In Ghana, it is worth noting, women play an enormously significant role in the media, reflecting their importance in society and the economy. Ghana is now one of only three sub-Saharan African countries which appears in the top 30 of the world press freedom index. This set of principles will be particularly important in the countries impacted by the Arab spring, specifically Libya.
	The paper highlights how, from Sierra Leone to Afghanistan, we are learning that we cannot build stable states without a properly functioning justice system. But for a justice system to be effective, and to build confidence among the public, again a free media is crucial. Justice always needs to be seen to be done, and that means that someone independent has to report it and ensure accountability in the system. The same is true, as the paper points out, for the accountability and legitimacy of the security services.
	There is also the issue of corruption. The strategy document admirably sets out how corruption, discrimination and violence against women or children,
	"fuel the grievances of the population".
	I have to say again that a free press and bad governance do not coexist, because free media hold those in positions of power and influence to account. Establishing independent media that are prepared to undertake this watchdog and scrutiny role is vital to rooting out corruption and bad governance.
	There is also the vital question of economic growth. Lack of economic opportunity is most often cited, as the paper points out, as a cause of conflict, particularly among young people who, often out of desperation, join gangs, rebel group and other criminal organisations. Again, the link between a free and plural press and economic growth is well established. At its bluntest and crudest level, you will never find famine in a country with independent media, a point underlined famously by the Nobel laureate, Amartya Sen, back in 1994. He argued, rightly, that gross disadvantage is not tolerated in democracies with a plurality of voice and free media which underpin them. Only recently, in 2008, a report from UNESCO, Press Freedom and Development, set out in painstaking detail the linkage between growing economic prosperity and press freedom. It is a link that cannot be ignored. I certainly recommend the report in that regard.
	In all these areas, press freedom is crucial to achieving the aims of this strategy, to build stable, peaceful societies. I am pleased that the Government have committed in this paper to working with the media-among other groups-to impact on what it describes as the "dynamic amongst political actors". That is absolutely right. I would like to highlight three practical steps in such a partnership, which are, as my noble friend said earlier, likely to be long-term ventures.
	The first step is to invest in the training of journalists, and to harness the expertise that exists in this country, and in a number of other Commonwealth countries, to do so. This can be achieved by working with established in-country training institutions and experienced media organisations. It is crucial that this training is tailored to local requirements, as there is never a one-size-fits-all solution. Advice must always be sought from individuals and organisations who have a successful record in training, and not from government, or government-led organisations. That would be entirely inappropriate.
	Secondly, I believe we must encourage the removal of barriers to the development of a free and independent media in countries that are at risk, including licensing systems of the sort that exists, for instance, in Zimbabwe, statutory press controls, and laws such as criminal libel, all of which make the establishment and work of a free press exceptionally difficult.
	Finally, I strongly believe, following what my noble friend said earlier, that we should encourage women to play a more active role in the media, especially in developing countries. The strategy document highlights the key role of women in achieving stability in societies, and there could be no better way to enhance that than to make sure that they have an active voice in the media.
	This is a very welcome initiative and an effective framework for the Government to move forward. I hope that the debate we are having today can help identify areas such as this, for further work and consideration, as we set about building, with our international partners, the stable societies which are vital for peace and prosperity across the globe.

Lord McConnell of Glenscorrodale: I, too, thank the noble Baroness, Lady Falkner, for securing this debate, not least because it is taking place at a particularly appropriate time. This year we have seen not only real progress in the international processes for dealing with stability, peacebuilding, post-conflict reconstruction and conflict prevention; we have also seen the temperature change. We have seen further progress in the United Nations and the Peacebuilding Commission, and in the different agencies of the United Nations, and a further momentum towards improvements in the way in which they support those trying to build stable societies out of previously conflict-affected states.
	We have seen a tremendous report from the World Bank-the World Development Report-which provides a route map for all of us, particularly the international institutions, for the way in which they need to tackle this challenge. In recent weeks we have seen the European Union agree to review the Gothenburg Programme before the end of this year, through the Foreign Affairs Council, and so again make its contribution towards this end.
	We have also seen real progress in individual actions that can provide momentum for those of us who believe that change is possible. We do not have to have conflict-affected states in a permanent state of conflict. There is a potential for change. We have also seen actions this year that challenge the pessimists.
	There are those who say that there are countries where democracy is never possible; cultures where democracy will never grow and where independent institutions will never be respected. We have seen people across north Africa and the Middle East this year demand those independent institutions-transparent, democratic frameworks in which to live and develop their societies. That should hearten all of us and convince us that where that demand exists, we can help and support those countries, through existing international frameworks, towards stability, progress and growth.
	These issues are important for us in this country because they affect us directly by the encouragement of drug trafficking and human trafficking and by providing hiding places-and, in many ways, growing places-for terrorism and other challenges to our security. But they also affect us because they are issues of global justice. It cannot be right that half the children in the world who die before the age of five will die in conflict-affected or fragile states. It cannot be right that not one of the fragile or conflict-affected states anywhere in the world is in a position to meet even one of the millennium development goals.
	Stabilisation across the world is an issue for our security, but it is also an issue of global justice. That is why it should concern us. The ability of the international community to support conflict-affected and fragile states to a position of stabilisation, prosperity and growth is the single biggest development challenge of our time. In the period ahead, as we move from the millennium development goals to a fresh challenge set by the international community for the next decade and beyond, this particular challenge should be the one that the international community sets as its number one priority.
	We all now know what is required: greater international leadership, and better in-country leadership, both from the elected Government and from the international community, working together. Stronger, firmer co-ordination is needed. I have heard Paul Collier say on a number of occasions that everyone talks about co-ordination, but nobody wants to be the one who is co-ordinated. But greater co-ordination among the agencies, and throughout the international community, is essential.
	It is a long-term commitment, and it is important to stick with it, going beyond national-level support for countries coming out of conflict, and going deep into communities to resolve local conflict and long-standing issues of identity and mistrust. It is about changing international institutions in the way that they approach these issues, as highlighted by the World Bank. It is about coming together, compromising and accepting the leadership of others; not always looking after your own internal interests but working collectively as an international community to support societies in developing.
	It is also about early wins in social and economic development. Yes, it is about the rule of law, democracy and better governance, but it is also about proving to populations that through jobs, and through educational, health and water improvement, there can be real change in local communities as a result of peace, and that conflict is never going to be the answer again. The United Kingdom is in a unique position to help with these challenges. We are not only a member of the UN Security Council and a leading member of the European Union; we are also active in the OSCE and a key participant in NATO, and we have the incredible breadth of the Commonwealth in which we participate across the world.
	We also have a record on aid and a leadership-in recent years in particular-on these kinds of issues that gives us a unique position in which we can contribute to this international debate. I had the absolute privilege of serving as the Prime Minister's special representative on peacebuilding for two years, from 2008 to 2010, serving with the noble Baroness, Lady Kinnock, and her predecessor, the noble Lord, Lord Malloch-Brown, in the Foreign Office, but working across the departments.
	The UK was at that time, and I believe still is, leading the international debate on this issue. We need to ensure that in the United Nations, the World Bank and the European Union, and elsewhere, each of these institutions addresses this issue consistently, coherently, and with firm resolve, in order to ensure that no more time or resources are wasted. We must ensure that in every country where there is a UN mission, there is fast and effective action working with the elected Government of that country, to take the mission forward and ensure that the mission will not still be there in five, 10, 15 or 20 years' time, as has far too often been the case in the past.
	For every good example, such as Sierra Leone or Rwanda, where real progress has arisen out of terrible conflict over the past 10 or 20 years, there are bad examples too. I saw some terrible examples of lack of co-ordination or misappropriation of resource. One country in particular had had its national police force trained by nine different nation states from around the world, in different police techniques, in a three-year period. The Justice Minister in that developing country despaired of ever having a coherent set of police standards in her country that could be taken forward with the trust of the population.
	I saw political stalemate in Nepal, Bosnia and elsewhere, where politicians were unwilling to compromise in the national interest, and the international community struggled to force them in that direction. So there are problems and bad examples, but there are good examples too. We have seen economic progress in Sierra Leone, and progress in terms of governance and the creation of institutions in Rwanda and elsewhere, as well as the participation of women in countries such as Rwanda, which now has the highest levels of women's participation anywhere in the world. There is the potential for progress. We should highlight those examples at the same time as dealing with those that are falling behind.
	I want to make three brief points before concluding. First, the UK needs to continue to practise what it preaches. I welcome very much this strategy and the new Government's commitment to continue with the cross-departmental approach begun by the previous Government. I also welcome their commitment to the Stabilisation Unit, the Conflict Pool and the other mechanisms under the National Security Council that we hope will allow the UK to be as effective as it has been this year in Libya in this regard.
	Secondly, I also want to see further progress on the international stage. We need to ensure that there is accountability; that the responsibility for action within individual states is clear; that there is fast and effective action and that the international community is pulled together by those of us who contribute to each of those institutions in every state where they have a mission. The regional organisations have a key part to play in the longer term. It is not possible for a body the size of the United Nations, the World Bank or perhaps even the European Union to play the sort of role that a neighbourhood, regional organisation can play in somewhere like west Africa or even in south-east Asia and elsewhere. It is important to build up the regional capacity. There are two great African proverbs. One is that rain does not fall only on one roof; it falls on several roofs at the same time and therefore conflict affects everybody in a neighbourhood. The second is that if your house catches fire, the first people to help are your neighbours when they bring buckets. You do not wait for the fire engine. Neighbourhoods are becoming increasingly important in this respect but help from the African Union, ASEAN and others is also vital.
	My next point has been mentioned, so I will not labour it. However, it is fundamentally important that women should have a role not only as elected politicians, community leaders and mediators-they are not used enough in that regard by the United Nations and others-but also as entrepreneurs and leaders in every field of society. The post-conflict societies where women occupy leadership positions at every level are those that are making the most progress. That is not a coincidence; it is a reality that we should continue to encourage.
	It is not possible or desirable for the world to continue to increase the number of peacekeepers year after year as we have done in the past 40 years. It is almost scandalous that every UN peacekeeping mission that has ever been set up is still in place. There are now 120,000 UN peacekeepers across the world. If a small proportion of the budget that is spent on those peacekeepers was spent on peacebuilding and post-conflict reconstruction and stabilisation, it would make a huge difference. The loss of human potential and the scale of human misery associated with conflict should make us strive more and more in that direction. I hope that as the Government take forward this strategy, they will do so with vigour, dynamism and enthusiasm. They will certainly have my support. The 21st century provides us with many challenges but it also provides us with an opportunity to make this strategy work in practice.

Lord Chidgey: My Lords, I, too, welcome this debate and congratulate my noble friend Lady Falkner on securing it. I am pleased to follow the noble Lord, Lord McConnell, who reminds those of us who take a great interest in the affairs of the developing world of the stark reality of the impact that instability and conflict have on developing communities in terms of poverty, sickness and the denial of basic rights of education and a reasonable life. This affects many communities, and not just African countries such as Sudan or the Congo. Afghanistan is a classic case in point. We should not forget the terrible situation that existed in the Balkans. Therefore, I welcome the debate and I welcome very much the Government's paper, Building Stability Overseas Strategy, about which I wish to make some detailed remarks.
	Part one concentrates on the reasons why we should engage in conflict prevention and why stability matters. As recent international events have clearly shown, there is little to disagree with in this assessment. Part two of the paper, however, is where the meat of the argument, discussion or analysis-whichever way you want to put it-lies, dealing, as it does, with the concept of early warning, improving our ability to anticipate instability and conflict triggers. It deals with rapid crisis prevention and response, improving the ability to take fast, appropriate and effective action to prevent crises developing, spreading or escalating. The final section deals with investing in upstream prevention, building strong institutions and robust societies in fragile countries able to withstand and manage tensions and shocks, reducing the potential for instability and conflict. That should be underpinned-it must be added-by democratic accountability, locally and nationally.
	Within the concept of early warning, the production of a watch list of fragile states and an early warning report based on a Cabinet Office six-monthly review of countries at risk, and assessed by the building security overseas steering group for overall efficacy, are all appropriate measures. There is no question of that. They do, however, suggest that previously departments of state went about conflict prevention in a more ad hoc and unco-ordinated manner. The danger is that these high-level initiatives will not be followed by positive action at working level. In the context of early warning there is a need to ensure that evidence gained from these initiatives is acted on in a timely manner. For example, the UNPD produces a monthly early warning report, which originates in the field, on countries at risk. Rarely is it acted upon in a timescale that prevents further deterioration of a situation. To quote senior officials,
	"there is often too much process and not enough progress".
	Therefore, my first concern that I ask the Minister to address relates to the processes that will be established to ensure that departments, particularly DfID, are recording and then working on indicators produced by the early warning report and annual horizon scan. Too often these outputs are read and then just filed while existing planned programmes continue stubbornly on their way unaltered and unaffected.
	As regards crisis prevention and response, the BSOS recognises the speed at which events can change and stresses the UK's comparative advantages in adaptability, speedy action and whole-government approach. That is very worthy. The creation of a £20 million annual early action facility within the Conflict Pool seems to underline this. Given the anticipated greater use of stabilisation response teams, as first deployed in Libya earlier this year, can the Minister provide details of the composition, training and availability of personnel for these SRTs? Are they to comprise serving civil servants from government departments and military personnel drawn from the MoD? Will they be held on the strength of the Stabilisation Unit or will they be called on as required? How are their training, availability and fitness for deployment to be monitored? Will deployable civilian experts or civilian stabilisation groups be deployed or will it be a combination of both? Again, how will they be recruited and trained? Is the Minister confident that the core team at the Stabilisation Unit is of sufficient size and has the right expertise to deal with rapidly changing scenarios, and that the right mix of DfID, MoD, FCO and Cabinet Office staff will be maintained? In this regard, are these civil servants and military personnel to be "double hatted" to ensure that we get value for money in periods of calm between crises?
	The Minister will be aware that in its responses to the BSOS document Saferworld suggested that the Government could build on their multilateral aid review and the BSOS by evaluating the impact that multilateral institutions have on prospects for promoting peace and sustainable security. Saferworld has also suggested that the scope of the Government's analysis of multilateral institutions should be expanded beyond those with which the UK has an aid relationship; for example, to the UNSC, the African Union and the OSCE. What is the Government's assessment of the usefulness of such measures, and are they considering implementing them?
	A number of noble Lords have mentioned investing in upstream prevention. Upstream conflict prevention requires, in part, developing a thorough understanding of what generates conflict within or between communities. As Saferworld points out, responses need to address both underlying drivers of conflict and the factors that lead to it becoming violent. The BSOS considers that work to prevent conflict is most likely to succeed when it marshals diplomatic effort with development programmes and defence engagement around a shared integrated strategy.
	The Government are providing more resources for upstream prevention through the Conflict Pool, which provides joined-up delivery across DfID, the MoD and the FCO. Stronger results focus and improved programme management will be introduced as part of this process. As I understand it, some £1.25 billion worth of funding will be provided for the BSOS, which will include investing in partnerships beyond fragile-state Governments in, for example, key groups such as local government, the private sector, faith groups, civil society and the media, as previous speakers have discussed.
	The to-do list includes work to reduce corruption and enhance the role of women. It also includes ensuring that the defence engagement strategy sets out clearly how a commitment to direct more non-operational defence engagement to conflict prevention will be implemented. The BSOS also provides an opportunity to set out the Government's analysis of how the broader international aid effectiveness agenda impacts on conflict and fragility and how it can promote dialogue on ways in which aid can support peace and stability in fragile states.
	As many noble Lords will know, the Government have been co-chairing the International Dialogue on Peacebuilding and Statebuilding that will feed into the Fourth High Level Forum on Aid Effectiveness in Busan. The UK is seen as a world leader in this area and in many other international initiatives that are taking place. Do the Government agree that a vital aspect of their programme and that of the Building Security Overseas Strategy is investing in the development of democracy in fragile states, investing in strengthening Parliaments and in their capacity to hold Executives to account, and in monitoring the delivery and effectiveness of aid projects?
	With regard to the overall extremely worthy, not to say challenging, to-do list, can the Minister elaborate on how engagement with civil society and faith groups and how efforts to reduce corruption will be undertaken in practical terms? What procedures are envisaged for facing host Government opposition and observing key, defined and stubborn local ownership practices? How will they be monitored and evaluated?
	We seek clarification of the monitoring and evaluation and results framework that the BSOS will use to assess the long-term impact of actions taken to prevent conflict upstream. These actions frequently concern changes in institutional and individual policies, along with attitudes of behaviour, which are very difficult to measure. How do the Government plan to overcome these problems?
	In its response to the BSOS report, Saferworld stresses that a key aspect of evaluating upstream conflict prevention should be the measurement of public perceptions of safety and security in conflict-affected and fragile states. It also sees a need to include an assessment of how well conflict-affected communities have been included in the planning, implementation and monitoring of the UK's conflict-prevention work. The BSOS does not set out how measurement of upstream conflict-prevention efforts or its rapid crisis-prevention and response activities will be achieved. It will be helpful to know what criteria and what indicators will be used, and which organisation in London and in the field will be responsible for this onerous and costly responsibility.
	Finally, the successful implementation of the BSOS will require the closest possible co-operation between key departments-the FCO, DfID and the MoD. This will not just happen. The creation of the National Security Council will provide that umbrella but that will not in itself ensure that the three departments adopt a common approach. It can happen only through making sure that key players establish working relationships and come to appreciate the different cultures and skills that the other departments can bring to the table.
	There have already been some very good reports on the outcomes of joint exercises, which have brought together the three departments to work together on resolving problems that require military, diplomatic, humanitarian and aid interventions. I trust that Ministers will now ensure that there are more such opportunities for the departments to work together on such exercises to maximise the chances of success when we have to deal with real situations in the real world.

Lord Hylton: My Lords, I join in the thanks that have been expressed to the noble Baroness, Lady Falkner, for securing and introducing this debate. It is good to be able to welcome a joint paper from three government departments. I hope that the Department for Business, Innovation and Skills will study this in relation to our military exports.
	I suspect that the work of producing this paper may have been more important than the document itself. The paper has a wide focus on the whole world, so it can seldom be specific. However, in just one paragraph, 3.5, it mentions that by 2025-that is, in 14 years' time-2.8 billion people in 48 countries will be facing water shortages. The signs are already obvious. The Aral Sea, for example, is largely dry. The Jordan is reduced to a trickle, while the Dead Sea has receded by several hundred yards. I saw this myself last year. In China, the Yellow River now seldom reaches the sea and some Pacific islands have to rely on imported bottled water. All these examples are mainly caused by human activity.
	At the same time, the world's population is rising steadily and will do so for some years before it is likely to level off. Climate generally seems to be getting more extreme so that some areas have serious and disastrous droughts while others suffer typhoons, hurricanes and floods. The stresses and tensions over resources are likely to get worse.
	If one looks at eight of the world's major rivers, all flow through two states and many traverse three or four. The fresh water in them is crucial for human consumption and for food production, as well as for other uses. In some regions there are already consultative processes for discussing water use and allocation but in others nothing is set up. Already the Euphrates and Tigris are causing much concern. In Turkey, more irrigation and more hydro-electricity are planned. Downstream in Syria and Iraq, some former farmland is turning to desert, whose production cannot be balanced by just increasing irrigation.
	The report, rather charmingly, speaks about "investing in upstream prevention". Will the Government take this both seriously and literally? Will they discuss with the major riparian states the need to establish dialogue and consultation on whole-river strategies for co-operation? Is this something that the Commonwealth could usefully promote among its members, not only in Africa but also, and especially, in the context of détente between India and Pakistan? The report is helpful in setting down what we mean by conflict and suggesting that this becomes problematic only when it turns violent. Some countries, which might otherwise be quite prosperous, such as Colombia, have a tradition of civil war.
	The report goes on to mention frozen conflicts. In my experience, in Moldova, Georgia and Nagorno-Karabakh, the conflicts frozen following ceasefires almost always have an external as well as an internal dimension. I suggest that interested external parties should not be called upon to act as mediators. Will the Government concentrate greater effort on resolving frozen conflicts, especially when British NGOs are already involved? This also makes sense because the unresolved conflicts cause poverty and make people migrate, as we have seen, for example, from Armenia, Moldova and Kosovo, the last of which we debated on 15 September.
	The report ticks many important boxes, such as the role of women, reducing corruption, justice and law enforcement, or political reform in the Arab states. It speaks of helping to build strong, legitimate institutions able to manage tensions, and it mentions the EU, the OSCE, the African Union and the Economic Community of West African States. Of those, nearly all have their own internal weaknesses. They have nevertheless made a start, and regional groups for preventing war and other disasters should be encouraged everywhere.
	I conclude by posing a more fundamental question. In Britain, we still have memories of the days of Empire, when our sea-power enabled us to impose our will in most parts of the world. In today's circumstances, should we not adopt a narrower focus and select those regions where we can best contribute to preventing violence and promoting good government and economic prosperity? Would we not be more effective by concentrating our efforts on, say, south-east Europe, the Middle East and North Africa, and perhaps the Horn of Africa? We have historic responsibilities arising from the Middle East but also much local knowledge and expertise. Progress towards resolving the long outstanding issues of Israel and Palestine would be a huge benefit to our interests, not least in reducing the motives for terrorism and in helping the Arab spring to produce worthwhile fruit. Progress, I believe, is likely to depend on work with the many shades of political and public opinion as much as on negotiation between the elites in government in the various countries.

Lord Sheikh: My Lords, I thank my noble friend Lady Falkner for securing this debate. This is an important and timely debate and an area of policy in which I have had considerable interest for a long time. The Building Stability Overseas Strategy is of great importance to our domestic and international interests. It is focused and comprehensive in identifying three pillars upon which the strategy is formed: early warning; rapid crisis prevention; and response and investing in upstream prevention.
	The early warning system makes a commitment to produce an internal watch list of fragile countries that have the potential to become unstable over a 12-month period. The watch list is subject to an annual review. I welcome this requirement, as it will ensure that our efforts are targeted at the most fragile regions. Early intervention may prove to neutralise tensions among warring factions. We can take the lead, along with our international partners and supranational organisations to prevent conflicts from occurring.
	The rapid crisis prevention and response pillar comprises a stabilisation response team, as mentioned in the strategic defence and security review. The progress made by the stabilisation response team deployed in Libya last May is a testament to the importance of such an initiative in promoting stability. By investing in the upstream prevention of instability, we can ensure that our aid goes towards promoting democracy while addressing civic challenges in fragile nations.
	I welcome the announcement that 3,000 former combatants will be re-integrated into civilian life in Nepal by 2015. I would be grateful if the Minister could elaborate on the progress made by Her Majesty's Government in meeting this target. I visited Nepal last July, where I inaugurated a business school of excellence in Kathmandu.
	I am also involved in helping with the trade delegation that will be visiting Nepal next week, and I am pleased that our ambassador to Nepal is participating in the arrangements of the visit. I feel that we need to develop stronger business links with overseas countries which will help our economic situation and build bonds between us and other countries.
	The Secretary of State for the Foreign and Commonwealth Office has recognised that untapped potential. He has undertaken to overhaul our network of foreign embassies to turn them into engines for trade, supporting the Government's ambitions for an export-led recovery from the current economic situation. There is good will towards the United Kingdom, but we need to build on these relationships to achieve mutual benefits.
	I am pleased that the Building Stability Overseas Strategy mentions this vital element. Our diplomacy should recognise the importance of greater dialogue among the Department for International Development, the Ministry of Defence and, of course, the Foreign and Commonwealth Office. Those departments are paramount to achieving progress through preventive diplomacy, and should form an integral part of any decision to embark upon any intervention overseas.
	I am encouraged by the fact that that strategy has been developed by the various departments. In helping fragile nations to build institutions, we can make a vital contribution in furthering our national interests. Building institutions is important if we are to achieve progress. In addition, we should also of course assist in bringing peace and stability, making democracy work, helping economic growth, creating jobs, empowering women and children and helping to deal with poverty and lack of education. I emphasise the need to empower women and raise their standards of education.
	The challenges facing our nation and the world at large require a multifaceted approach to our conduct of future relations. In recognising our status in the global arena, we have a role to play in preventing the rise of dictatorships and rogue states. Democratic values and freedom should be at the heart of our approach to international and foreign affairs. Our policies and actions must support countries that aspire to achieving democracy and ending the oppression of citizens. It is vital that the strategy should enable us to work more effectively with our international partners such as the Commonwealth nations and the European Union.
	I have spoken on several occasions in your Lordships' House about the importance of the Commonwealth. I feel that the Commonwealth may play a greater role in conflict resolutions and promoting trade between the various countries.
	I am pleased that there are now closer links between Commonwealth countries and Sri Lanka. I have visited Sri Lanka, where I was impressed with recent developments following the end of hostilities. I am a strong believer in the merits of education and its ability to contribute to stability in fragile nations. I feel that we must build connections between universities in the United Kingdom and educational institutions overseas.
	Through initiatives such as the Union for the Mediterranean, the European Union has a part to play in the reconstruction of countries in north Africa, following the Arab spring. This is reminiscent of the role played by the European Bank for Reconstruction and Development in helping countries in central and eastern Europe to achieve democracy and build a free market economy following the collapse of communism.
	I have visited both Egypt and the Gulf region in the last six months, where I have spoken with citizens about the challenges facing their countries. I feel that our involvement in any such country must be soft; we should exercise soft influence. When I visited Egypt, I found that the Egyptians had very high expectations. Although we can provide assistance to the people of a country where there are problems, the people must themselves find the solution and form a system which suits their circumstances. We should not expect foreign countries to adopt our form of government and there should be no attempt on our part to do so.
	I have always supported the Government's plan to ring-fence the international development budget. However, I remain concerned that there is consternation among the general public about this commitment. I would therefore be grateful if the Minister could provide information on what Her Majesty's Government are doing to inform the public that this makes a vital contribution to stability in fragile nations.
	I also welcome plans to boost the resources of the conflict pool and efforts to expand the Arab partnership initiative over the coming four years to support economic and political reform in north Africa and the Middle East. The tragic loss of life as a result of the Arab spring must not be in vain and it should be used to promote commerce and a strong civil society in these nations to make them free from corruption. Achieving peace and stability in any region that has been ravaged by war and has a wealth of cultural differences is always a challenge. It is important to recognise the strong regional dynamic of the barriers to peace in any region. By focusing on individual nations, the risk of instability in neighbouring countries must be heightened as ethnic divisions transcend borders.
	Foreign policy and national security are intertwined and should be treated as such. The success of our foreign policy will work to promote our national security and interests both at home and abroad. We have the capability and intelligence to identify volatile regions where there is a danger of an outbreak in hostilities. World history is littered with examples of the repercussions inherent in a failure to identify unstable regions or places that have the potential to descend into instability. Government departments involved in forming this strategy deserve praise for devising a scheme that is both pragmatic and strongly relevant to the challenges facing both Britain and our national interests overseas.

Lord Desai: My Lords, we are grateful to the noble Baroness, Lady Falkner, for introducing the debate. I compliment her on her speech, and say all this because I will be quite critical of the document we are discussing. I find it intellectually inadequate and do not think that it can be a basis on which to frame any sort of policy. I shall go into some detail about why I think that.
	It is economically deterministic and takes a rather naive view that in any conflict there are bound to be economic causes, and only economic causes. In proposing a solution, it has the defect of all the UN documents that I have had to read over the years of being far too idealistic in the requirements that it imposes on what kind of a perfect solution there has to be. Everything has to be democratic, transparent, accountable, gender-friendly, environmentally sustainable and what-not. I once headed something called the Centre for the Study of Global Governance at the London School of Economics and, on one of the first discussion papers we published, a brilliant Canadian scholar pointed out that people sitting in New York ask their UNDP branches out in Kenya and so on to add new things that they have suddenly thought of that we must have in conflict resolution. We do not have to do it but people out there have to satisfy so many constraints. At the end of it, whatever we do will be inadequate.
	I start by saying why I think that the document is analytically defective. Then I will say something about the solution. First, the document is analytically defective because the notion of a fragile state is not an adequate notion. Most things that are called fragile states are not states. They are not even nations. Because of various things, either colonial developments, or something else, they have been designated as states by some constitutional accident but then have followed a long struggle to find out whose nation it is. Consider Afghanistan, where we have had trouble for 40 years. It was a kingdom once upon a time, and as kingdoms go it was stable. In a kingdom you can command the loyalty of different tribes who may not agree with each other. Then there was the communist revolution and other things later on, and we are still trying to establish a nation state there. A nation state is very different from a kingdom. In a nation state, numbers count and different tribes have to quarrel to take command of resources. The notion that everything is a state is inadequate for analysis of fragility.
	I even say, at the opposite end, that we should consider Sri Lanka. Virtually everything that people want-gender friendliness, good health, education, a fantastic welfare state, high literacy, high ranking of human development-was reported over the years. What happened? Almost horrendous genocide takes place there in a 25 year-old civil war. The notion of a fragile state does not help us to analyse Sri Lanka or Zimbabwe. Until the late 1990s Zimbabwe was thought to be an ideal combination of social development and economic growth. I was part of the UNICEF project. In an article somebody listed Zimbabwe as one of the 10 most successful countries combining social development and economic growth. Why did Zimbabwe fall apart? This document will not help us to explain that. We have to be much more critical.
	What are we being asked to intervene in? We may be asked to intervene in situations not because states are fragile. None of the states in the Arab spring revolutions was at all fragile-not Egypt, Tunisia, Libya-but all were subjected to considerable change and had to respond to it. I urge Ministers to look again and to have a more robust doctrine on why we have to have early warning and on what we can do. We were able to do nothing about Sri Lanka despite it being a member of the Commonwealth. We were not able to expel it, like Zimbabwe, or even Pakistan. It not only continues to be a member but will host the CHOGM in 2013. We need a slightly better concept of not just fragile states, but rogue states and maybe states that are perfectly well functioning but which because of that can be perfectly efficient at oppressing their people. Iraq, for example, under Saddam Hussein, was not a frail state at all-not even a fragile state. It was a very powerful state but it was oppressive to its own people.
	The doctrine of liberal interventionism, of which I think I am the last friend, says that if you live in a global village and see a neighbour beating his wife you will intervene. You do not regard it as his affair. If a country-especially a non-western country, if I may say so-has a dictator who is eliminating some part of the population through genocide and so on, we do not say, "No. Their values are different, so we cannot intervene". I think that it is quite right to intervene. It was right to intervene in Iraq. I have no problem with that. Iraq today is a democracy. Not only that, I believe-although I cannot prove it-that some of the inspiration for the Arab spring must have come from the fact that Iraq was seen as a functioning democracy. It is such a stable functioning democracy that after the elections it did not have a Government for six months but still nothing happened that could upset the political balance.
	That is an achievement and that kind of liberal interventionism was successful in Bosnia and Kosovo and very effective in Sierra Leone. We have to learn positive lessons from that. We cannot just rely on the doctrine of fragility. Maybe we should have "fragile states"; we should have "rogue states"; we should have states that are perfectly all right but suddenly undergo a conversion-in all these different situations we may be required to intervene and what kind of intervention we make will be important.
	Time is running out so let me say a few things on the ideal solution. It is very important, especially in fragile states, states that are breaking down, or even states in which we are intervening, that we prioritise what kind of intervention is needed. Before all the democracy and accountability and transparency-all those good things of life-are achieved, we have to restore law and order. The restoration of law and order and the security of property and people is absolutely the top priority. In doing that you may not achieve all the good bits that you want to achieve. Very often, especially after a civil war, it would be very difficult for even the domestic security forces, let alone somebody from outside, to really be able to give proper, perfect equal justice to people who were previously the masters and committing the genocide-just think of how it was in Rwanda. First should be some sort of security of property and life on an equal basis, and later one can go on to look at institution-building and things like that.
	How many years did we stand by and wring our hands over Darfur and all the time the crisis was happening? Was Sudan a fragile state? Was Sudan a state at all? Now coming out is what we knew all the time: that Sudan had very deep divisions, north and south, on the basis of religion. At that time we were not able to operate on the idea that perhaps Sudan should not be a single country. My own private view is that the Democratic Republic of Congo should not be a single country and is not viable as a single country, but that is for another day.
	As far as Her Majesty's Government are concerned, if you are going to set up an early warning system, please have a much more robust analytical model on the variety of different situations in which we will have to intervene and not just this notion of a fragile state and that it is fragile because it is economically weak. That will not do; that is not a proposition which would pass any examination. Therefore, we should be deeper in our analysis and economise on the objectives we pursue when we intervene-and once we intervene, get out fast.

Lord Hussain: My Lords, I thank my noble friend Lady Falkner for initiating this important debate. I welcome the Building Stability Overseas Strategy as it clearly stipulates the importance of peace and stability overseas and its impact in the United Kingdom. I sincerely hope that in pursuance of this strategy, among other things, we will be able to bring an end to what is perceived by many in the outside world as double standards on our part when dealing with conflict zones; for example, our active participation in response to the situations in Iraq and Libya versus the laid-back and semi-neutral position in the cases of Palestine and Kashmir damages our credibility and reputation in the eyes of many.
	May I take this opportunity to remind the House of the Jammu and Kashmir issue which is one of the oldest conflicts in United Nations history? The Kashmir issue goes back some 64 years. Many people outside the Indian subcontinent have lost track of this and others may have forgotten about it, but Kashmiris do not forget it. I was born in Kashmir and have friends and relatives living both sides of the line of control, and would like to remind the House of some of the facts on this issue. First, as many Members of this House will be aware, India took the matter to the United Nations in 1948 and the first UN resolution of 13 August 1948 promised a plebiscite for the Kashmiris to decide about the future of the state. This was followed by many similar resolutions. Both India and Pakistan made numerous public pledges and statements honouring the promised plebiscite. The famous words of India's first Prime Minister, Pandit Jawaharlal Nehru, are part of history, when he said: "It will be Kashmiris who have the final say about the future of the state of Jammu and Kashmir. At the end, even if they decide to stay separate from India, we will swallow that bitter pill". Those promises were never kept.
	Since then, India and Pakistan have been to war three times. There have been many formal agreements, including the Tashkent Declaration in 1966 and a similar agreement in 1972, when both countries agreed to resolve Kashmir through negotiations-but they never did. Kashmir remains one of the most heavily militarised zones in the world. India's 700,000 armed forces, with special powers given to them under the notorious Armed Forces (Special Powers) Act, are committing some of the worst human rights violations in the world. Killing, rape, arrests and torture are taking place regularly; for example, the incident of Kunan Poshpora, where the whole village was rounded up by the Indian army, the men and boys detained in the nearest army camp while girls from the age of six to elderly women of the age of 80 were all gang-raped by the forces.
	This and many other such cases are well documented and reported by Indian human rights organisations. In the last 20 years, more than 100,000 people have lost their lives. Tens of thousands have left their homes. Thousands have gone missing, while 2,800 mass graves have been identified with no knowledge of the victims. This needs an international independent inquiry. According to Amnesty International, India is using draconian laws such as the Jammu and Kashmir Public Safety Act to arrest, torture and detain people from two years to up to 20 years. According to its report, 16,000 to 20,000 people have been arrested under this law so far.
	Periodic, bilateral negotiations and so-called confidence-building measures between India and Pakistan have proved to be no more than minute gestures which are often halted, derailed and discharged, and are used as a time-passing exercise and nothing more, as far as Kashmiris are concerned.
	Jammu and Kashmir is not a territorial issue. It is one of the British legacy's unfinished agenda of the partition plan when we decided the fate of more than 500 such other princely states in India and left Kashmir bleeding. Not only do we owe it to the 12 million Kashmiris directly affected by this conflict to oppression, occupation, rape and torture on a daily basis, but also to a further 1.2 billion people of India and Pakistan. They could benefit immensely from better use of the multi-million pounds in the defence budgets that both countries are spending due to the conflict in Kashmir, while millions of people in both countries are living without houses, electricity or access to drinking water.
	Given the importance and helpfulness of the Building Stability Overseas Strategy, how does the Minister think that this strategy will help to resolve the long-standing issues such as Kashmir and will the Government consider taking the issue of Jammu and Kashmir back to the United Nations asking for the implementation of the UN resolutions? Will he raise the human rights issue with his Indian counterpart at his next meeting and press for an international inquiry into the mass graves? Will he ask the Indian Government to repeal the notorious laws, such as the PSA and AFSPA, and for withdrawal of the army from residential areas to start with? Finally, will he ask both countries for a complete withdrawal of their forces from the state to allow the plebiscite to take place?

Baroness Warwick of Undercliffe: My Lords, I join in the thanks to the noble Baroness, Lady Falkner, for securing the opportunity to debate this new Building Stability Overseas Strategy. I share her view that this is a timely and important piece of cross-government work, drawing as it does on much expertise and experience within the Foreign and Commonwealth Office, the Department for International Development and the Ministry of Defence.
	The strategy is bold and its aims are clear. This is essential if we are to respond effectively to conflict where it arises but, even more importantly if we are to anticipate and prevent triggers for future conflicts. The recent uprisings in the Arab region have been a reminder of how quickly and unexpectedly political landscapes can change. They also, I believe, reinforce the importance of our continued investment in governance in complex and challenging regions.
	When announcing the strategy earlier this summer, the Secretary of State for Foreign and Commonwealth Affairs noted that at its heart lies the conviction that stability can be achieved only when a society has the "strong, legitimate institutions" it needs to manage tensions peacefully. I share that conviction, which stems from my time as chief executive at the Westminster Foundation for Democracy during the early 1990s-a function that I shared with the noble Baroness-and my continuing involvement with Voluntary Service Overseas. I further believe that working with local, credible organisations, as do both these organisations, will continue to be a critical element of effective UK support for those legitimate institutions.
	Increasing the proportion of UK official development assistance that supports conflict-affected and fragile states to 30 per cent by 2014-15 is a bold decision. Explicitly focusing on unstable states is not an easy or necessarily an obvious option, because it produces potentially higher risks for those involved on the ground. I do not mean just the Armed Forces, of course, but the many involved in humanitarian work, aid workers, NGOs, the media and others engaged with civil society in those states. On the other hand, the emphasis on co-ordinating all the forces available-the 3D approach which puts diplomacy, development and defence into an integrated strategy of prevention-makes complete sense. It is, as they say, a no-brainer as the basis for a more effective approach to managing tensions, offering the greatest chance of success.
	I welcome the strategy's intention to create an early warning system to help us anticipate instability. I support its creation of a £20 million early action facility within the conflict pool to help us act fast to prevent a crisis or to stop it escalating. However, I believe that it is the third of the three pillars of this strategy-that of upstream prevention-which will be the most effective and most likely to succeed in the long term. It is here that I want to focus my remarks. Upstream prevention tackles the underlying drivers of instability before a crisis occurs, avoiding the enormous human and financial costs of conflict. As the Secretary of State for International Development, Andrew Mitchell, said in another place, upstream prevention,
	"goes to the heart of the drive to achieve better targeted, more effective aid",
	helping,
	"to improve the lives of some of the poorest and most vulnerable people on the planet".
	As the strategy reminds us, nine of the 10 poorest countries in the world are classed as fragile states. Five countries, all in the midst of conflict, produced 60 per cent of the world's refugees in 2009. It is right to focus our efforts on helping fragile states build those strong, legitimate institutions that provide the basis for trust and confidence. These institutions range from the police and legal systems to civil society organisations, religious groups, political parties, government departments and banks. The strategy is also right to emphasise that,
	"effective local politics and strong mechanisms which weave people into the fabric of decision-making-such as civil society, the media, the unions, and business associations-also have a crucial role to play".
	That is at paragraph 4.4.
	Bodies such as the Westminster Foundation have long recognised that working with local government, communities and the media is how we will reach the most vulnerable people. This so-called soft power is critical. I particularly welcome the recognition that our capabilities to ensure that this strategy is effective go beyond government. Our universities, NGOs, think tanks and the private sector have much experience and indeed expertise to offer. The Westminster Foundation works explicitly to help encourage democracy as it believes, as the strategy acknowledges, that democracy provides the best route to building accountable and responsive states that are able to promote social and economic development.
	Of course it has long been the work of the British Council, on whose council I served for 10 years some years ago, to build engagement and trust for the UK through the mutual understanding of our values. Our universities have also had a key role to play in this in their links with overseas institutions, their welcoming of international students through scholarship programmes -some sadly no longer funded-and their education of the future leaders of many countries.
	I have spoken on this issue previously but make no apology for referencing the vital role that educating and empowering women can play in building stability, as indeed did the noble Baroness, Lady Falkner, and my noble friend Lord McConnell. For example, I draw noble Lords' attention to the work of the Westminster Foundation in Sierra Leone, a country where concentrated action has had real impact. WFD helped build the capacity of elected women and women community leaders to take a greater role in political life following a decade of civil war.
	Working with local organisations that have credibility is key to all this. It is what will make upstream prevention a truly worthwhile and effective strategy. People directly affected by conflict offer unparalleled insight into changing dynamics but this is of limited value if local institutions are not in place with legitimacy to respond. As bodies such as the Westminster Foundation are working to show us, partnering local civil society offers the best chance that interventions will be relevant, legitimate and sustainable.
	So far so laudable, but I raise two related issues of concern. I do not feel they have been sufficiently addressed in this strategy and ask the Minister to comment. The first relates to evaluation. We are all feeling the impact of public funding cuts and will do so for some time to come. But we must see results when we spend substantial sums-I remind noble Lords that 30 per cent of UK official development assistance will go to conflict-affected states by 2014-5. We must also know that what we are spending represents value for money. The strategy makes only a passing promise of "rigorous internal and external ... evaluation" and an annual progress report within the public statement about SDSR. That is about it and that is not good enough.
	The strategy itself says that,
	"the overall evidence base and conceptual foundations for engagement in fragile states remain patchy, underdeveloped and, in some areas, contested".
	Yet the strategy proposes to spend millions in high-risk situations and high-risk states. Given the financial climate I am not impressed by the strategy's bland assertion that we need to be "realistic" about what we can achieve and about the pace of change. Can the Minister tell us about the evaluation to be put in place? Will we have the mechanisms to ensure that our money will be spent effectively? What are we learning from the evidence that currently exists on aid effectiveness in conflict situations?
	My second question is a related one: the issue of corruption in conflicted-afflicted states. We know that corruption is endemic in fragile states. It is not limited to the Governments, and misappropriation of funds is widespread. Instability is one of the drivers for organised crime. Yet when outlining why we should put more of our money towards supporting these countries, the strategy has very little to say about what it will do about tackling corruption to ensure that money is spent effectively. Indeed, as the Select Committee on Economic Affairs observed last month, it is pretty well silent on this issue.
	I am rather astonished by this. Guidance on applying the UK Bribery Act and supporting local efforts to tackle organised crime do not amount to a strategy to tackle corruption in fragile states. In the absence of any more detail in the strategy, my question to the Minister is whether our existing anti-corruption programme at country level is enough to support the delivery of this strategy and, if not, what are we going to do about it?

Lord Stone of Blackheath: My Lords, I too am grateful to the noble Baroness, Lady Falkner, for this debate and for her ever-present energy and smile in the House. I recall debating here as early as 1999 the idea of detecting areas of potential conflict. Then we suggested devising a plan for more subtle, non-military interventions before, or even during, a conflict and certainly after a conflict. In fact, more than 10 years ago, we were talking in this House about building stability overseas. Now that this has become a BSO strategy, with an agreement to draw on external expertise and cross-governmental co-operation, the next step should be to find pragmatic, large-scale projects that are already under way. They should be monitored and, if they are successful, could be replicated across the world under the strategy being suggested.
	In February this year, I reported on an example of such an intervention. It started three years ago in the Middle East-in the Palestinian West Bank and in Jordan. We called it Moon Valley. I must declare an interest as I have been involved, unpaid, in this project from its inception. It is a perfect example of a conflict zone which at this moment has the potential to erupt into a major war or settle into progressive stability. The Moon Valley project has opened the way to allow, in the future, thousands of Palestinian farmers access to the international market for food and agricultural products.
	The project has had great support from external expertise; Marks and Spencer, Sainsbury's and the Co-operative Group in this country, Whole Foods in America and Carrefour in Europe have been supportive. It is a good example of cross-governmental co-operation. The Foreign Office has been helping, particularly the consul-general in east Jerusalem, as has the Department for International Development, both locally on the ground in the region and here in London.
	Our perception is that the creation of stronger local enterprises, with firm backward linkages to the poor, creating jobs, opportunity and prosperity, are essential for the prevention part of this strategy. It is obvious that such a strengthening of well led, well managed, inclusive businesses is not going to happen automatically in these more conflict-prone regions, where investors will be more risk-averse. When such regions have benefited from the old-style aid handouts that were driven by political rather than economic reasons, this type of intervention creates a culture of aid and political dependency, which can be antithetical to social and economic development. That type of aid does not build strong, local, civil society institutions, such as business associations and unions. Instead it creates monopolistic regimes that specialise in bidding for and squandering aid.
	Moon Valley, on the other hand, has created trade. It is transferring technology and skills. It is planning to build a much greater capacity involving thousands of small farmers while still improving quality and reliability. Since February, to help this happen, DfID has sponsored a programme whereby an experienced NGO-Technoserve-is working with Oxfam and DAI, completing research into the entire agribusiness sector in the West Bank and Gaza. It will show that helpful interventions such as these can build a vital industry on an even greater scale and benefit tens of thousands of Palestinians. This kind of mindful intervention can drive the development of high-quality, export-oriented businesses, which operate on sound business practices, foster inclusion and enable people to influence the development of their own community and have a say in the future of their own country.
	It is exciting that since this initiative, interest in food from Palestine is being shown, not only by European retailers and supermarkets in America but, as my noble friend Lord McConnell suggested, by neighbours-that is, interested parties in the Gulf. All these countries and companies now have a growing need for a future supply of large quantities of high-quality food products; and there is a desire for them to be from Palestinian farmers, to help their cause. In some cases, parties are prepared to offer the possibility of providing up-front cash, in pre-orders, to allow us to scale up the venture to millions of pounds a year. The noble Lord, Lord Howell, is familiar with this project and has been very supportive in the past.
	Now, with this new BSOS strategy, I call on the Government, through the Minister, to organise high-level missions to various countries. The delegation would comprise representatives of our Government, together with Palestinians who are developing the agriculture in the West Bank and some of the experts who have been involved from Technoserve and Moon Valley. The quartet can also provide helpful support, and the Israeli Government have said that they can provide secure and reliable passage for the products' transportation. We would go together to several regions to put forward a plan and agree a strategy for Palestinian agriculture to become a reliable and viable source of high-quality food products on a worthwhile scale. In this way, this could become a model for other BSOS projects planned for the future in other countries, particularly the Middle East and north Africa.

Baroness Kinnock of Holyhead: My Lords, I thank the noble Baroness, Lady Falkner, for initiating this timely debate, which has offered all of us a wealth of expertise and analysis, which I and all noble Lords welcome. The report, as many noble Lords have said, has a number of very positive elements, which we need to follow very closely. It will, of course, involve the importance of holding the Government to account on this strategy. It is, of course, not a new agenda, because it was under the last Government that the stabilisation units and other initiatives were taken. For many years there has been an analysis and there have been efforts to link and integrate defence, diplomacy and development. Therefore, we have to applaud the joint strategy-we like joined-up government, do we not?-which is designed to bring coherence across DfID, the FCO and the MoD.
	The report acknowledges, as I know many noble Lords have done, that what we are talking about-indeed, conflict has been the central subject this afternoon-has repercussions for countries, individuals and whole regions. We have a comprehensive definition of stability in the strategy, which goes beyond definitions confined to merely the absence of war or to threats to national security. It also clearly and unequivocally identifies the need for humanitarian aid to be delivered on the basis of need alone. The strategy is also about recognising the need to be in for the long haul. If transformational results are to occur, clearly that has to be what we do.
	We should also welcome the commitments to the international arms trade treaty. On this subject, we know that the Arab spring raised many concerns about arms transfers that have taken place over a number of years, whereby arms are transferred by the UK to authoritarian Governments. More than 150 licences had to be revoked, for instance on sniper rifles, teargas, ammunition and armoured vehicles, which had been delivered to Bahrain, Egypt, Libya and Tunisia. It would be good to know what is being done to avoid a repetition of these mistakes. I would certainly appreciate it if the Minister could comment on whether we can expect a full-scale review with engagements with Parliaments, civil society and the arms industry. It is good to see that the early warning system will inform the work of BIS on arms export licensing.
	Stability is characterised not just by an absence of war but by promoting open, inclusive societies, which are the key to tackling fragility and conflict. We need to know more from the Minister about how it is anticipated that this will be achieved. Since 9/11, we have seen increasingly that development and security concerns have been linked. The lexicon is: fragility; radicalisation; stability. Many of us hoped that development objectives, when clearly identified, would deliver human security, but we have also feared the securitisation of aid, which serves only to compromise development and humanitarian activities. After all, DfID has now joined the National Security Council, and David Cameron has explicitly said that development aid,
	"is a powerful instrument of our foreign policy".
	Countries selected for aid increases-Afghanistan, Pakistan, Somalia and Yemen-are also all seen as actual or political terrorist threats. UK aid to Afghanistan is set to increase by 40 per cent over the next three years. It remains essential that aid is allocated according to need and not to serve short-term political or military gains. We know that since 9/11 we have increasingly seen statements from politicians linking poverty and alienation with terrorism, while we see military engagement with development work in order to win hearts and minds. People want security and justice, but communities must identify their own security priorities and concerns. Will the Minister confirm that the new approach will seek to meet the genuine security and justice needs of vulnerable people?
	I am also interested to know more about the distribution of aid. DfID has said that 30 per cent will go to fragile and conflict-affected states. Would the Minister care to clarify, now or later if necessary, whether this is bilateral or multilateral aid, or both? How does the new commitment fit with the limited number of countries-27-that will receive aid following the bilateral aid review? The criteria for country selection in the strategy are also not the same as in the multilateral and bilateral reviews; those identified are different. Paragraph 1.5 says:
	"where the risks are high, our interests are most at stake and where we know we can have an impact".
	I fail to see any reference there to criteria on improving the lives of poor people.
	What, then, is absent from the strategy? On military engagement, it addresses soft power and security sector reform, but what about the places where the UK is militarily engaged? The strategy is strangely silent on this. There is nothing at all on when, how or if military intervention is appropriate, or on checks and balances when it happens. Is this not a serious omission? It will also be necessary to address how potential tensions between the three departments will be handled, because I and many other noble Lords know that it cannot be assumed that there will not be tensions between the various departments. On the role of the MoD, when working with armed services overseas we need to know that the notions of the importance of human rights programmes, democratic oversight, gender equality and the accountability of security forces are understood and promoted. The FCO must lead on addressing the causes of fragility and conflict and ensure that conflict is firmly on the list of UK diplomats' priorities.
	There is such a lot to say on this subject, but I now turn to a serious lack of emphasis, to which many noble Lords have referred: clarity on the commitment that is to be made on the importance of women in peacemaking and peacebuilding, and, indeed, in tackling the appalling levels of violence that women experience. In every single aspect of this report, we should see a strong commitment to the integration and involvement of women. On early warning systems, we need to see indicators on levels of violence against women; on government co-ordination, I suggest that Lynne Featherstone, the Home Office Minister responsible for following violence against women overseas, should be engaged in the process and take part in NSC discussions in that role. On partnership and accountability, we should make a commitment to provide core funding for women's organisations in these countries. Security and access to justice is a critical issue because women have particular problems with accessing justice.
	Much more needs to be included, and I hope that consideration will be given to drawing up a focused set of policies now to address the fact that there are only fleeting references to women in the strategy and that it is necessary to come up with tangible and substantial commitments on this issue. Indeed, there is scant reference in the strategy to human rights more generally and no clarity about why human rights matter. In the context of the nature of the objectives of the strategy, this is regrettable.
	We are, of course, aware of the difficulties that we face when we talk about state-building, and a number of noble Lords have identified those difficulties. It is a highly political activity. Lessons have to be learnt from Afghanistan, for instance, where the state's loss of legitimacy and accountability is a major source of instability. The process has to be nationally owned, not devised or imposed by outsiders. That is critical. For instance, it took Portugal a decade to move from military to civilian rule, and this when they already had fairly strong institutions. We should learn from those kinds of examples.
	Finally, the UK must work closely with others. The OECD recently reported that there is generally a lack of co-ordination or even contact between those working on stabilisation. We need to reassess this and see how we can change it. In this and many other areas of policy, going it alone is simply not an option, and I trust that in future we will see more collaboration.

Lord Howell of Guildford: My Lords, we are deeply grateful to my noble friend Lady Falkner of Margravine for initiating this debate. It has confirmed once again something that is obvious and known to us already, but I repeat it: the staggering accumulation and store of informed expertise and experience available in this House that can be marshalled and focused upon issues such as the one that we are discussing today. As always, for all of us it has been a fascinating and a learning experience to listen to the views of your Lordships, many of whom have been deeply involved in the practice, assessment and implementation of the issues in building stability overseas and meeting our international aims, interests and obligations. I thank my noble friend Lady Falkner, as we have all done, and all noble Lords who have taken part. I welcome the chance to comment on the Government's strategy and on the statements that have been made, and to update the House on what the Government are doing to prevent and resolve conflict and promote stability overseas.
	The opening sentence of my noble friend's speech set the tone when she quoted President Kennedy in saying that the great issues of our times internationally are not susceptible to military solutions. There are great warriors around who are always telling us about defence expenditure and, as it were, measuring effectiveness by such expenditure, but that is the wrong measure-it is not the measure that counts any more. In this debate we are dealing with efforts, programmes and resources that are just as important in establishing what might be called "the new defence". It is not just a question of moral rectitude, but of our national interest. The truth, as many who are sitting in this Chamber now know, is that the texture of international relations has changed beyond recognition in the past decade or so. That was fully recognised by the previous Government, it is recognised by this Government, and recognised perhaps a little more slowly by the media and commentators who tend to go on repeating the shibboleths and mantra of yesterday. However, there is a new world which we must now address and cope with, and develop the instruments to battle with. That is what we have been discussing today.
	I announced in this House on 19 July the publication of the Building Stability Overseas Strategy, which was the first integrated cross-government strategy to address conflict issues, building on the work of the previous Government. The strategy took on board the lessons of the Arab spring and sets out three ambitious aims where the Government will concentrate our efforts. The first is early warning, where we will improve our ability to anticipate instability and potential triggers for conflict-a matter which my noble friend Lord Chidgey and many others raised. I will come to that in a little more detail in a moment. The second is rapid crisis prevention and response by taking fast, appropriate and effective action to prevent a crisis or stop it escalating. The third is investing in upstream prevention-again, mentioned by the noble Baroness, Lady Warwick, and many other noble Lords-by helping to build strong, legitimate and robust societies in fragile countries, a phrase about which the noble Lord, Lord Desai, had one to two characteristically acute and somewhat critical comments to make, to which I will also come in a moment. The strategy makes clear how we will try to deliver these aims, across the Foreign and Commonwealth Office, the Department for International Development and the Ministry of Defence, using our diplomatic, development and defence capabilities in an integrated way.
	Many of your Lordships have raised the issue of how, being a tri-departmental operation-as it is under the building stability overseas board-this can be properly integrated and co-ordinated. I do not want to sound like an ancient mariner, but I have now been in and out of Whitehall for 41 years and engaged on many occasions, right back to the new style of government in 1970, in wondering whether we should co-ordinate or disperse more, delegate or gather together. It is a sort of cyclical process. The impulse to co-ordinate activities, particularly the impulse to appoint a Minister who is going to be responsible, can often end in tears. The Minister may feel that he is responsible. Somehow all the channels are opened around him or her and, in the end, they co-ordinate nothing.
	One has to be a little worldly wise about co-ordination. The programme we have now, bringing together the three departments under the Building Stability Overseas Strategy, drawing on the resources of the Conflict Pool and delegating tasks to excellent organisations such as the stability unit is-we are entitled to say this with a little pride-working experimentally but extremely effectively as we go on into the new international landscape and events such as the Arab spring bring us new lessons and new ways of tackling these problems.
	We have announced the substantial extra resources to underpin this strategy. By 2014-15 we will have increased to 30 per cent the proportion of UK official development assistance that supports conflict states and fragile states. The 100 per cent UK-funded Arab Partnership Initiative will expand to £110 million over the next four years, to provide support for political and economic reform in the Middle East and north Africa. The resources of the Conflict Pool, jointly operated by the FCO, MoD and DfID to fund our conflict prevention work, will increase over the spending review period to a total for the period, as one of your Lordships mentioned, of £1.125 billion. Through the Building Stability Overseas strategy, the Government will prioritise those countries where risks are high, our interests most at stake and where we know we can have an impact. This involves-as your Lordships have emphasised-some difficult decisions about where to focus efforts and there is not always 20:20 vision about exactly how events will to develop or what crises will spring up.
	I should like to refer to some of your Lordships' specific comments, which have been very valuable, in the time available. My noble friend Lady Falkner began this debate so well with the quote that I have already mentioned. She urged the stabilisation unit to have a long-term perspective and I totally agree about that. She asked how we decide about really difficult issues, such as Bahrain, where we have seen some deeply concerning developments, particularly the ongoing disturbances; or Syria, where we have tried repeatedly to get an effective resolution through the United Nations. Our latest efforts, as your Lordships know, have been blocked by Russia and China.
	We urge the Government of Bahrain to meet all their human rights obligations and to uphold political freedoms, equal access to justice and the rule of law. These do not run contrary to security, but are integral to long-term stability. We believe that dialogue is the best way to bring long-term stability to Bahrain and we encourage the Bahraini authorities and opposition groups to show real leadership by engaging constructively with one another. Whether the latest news from Bahrain indicates some acceptance and realisation of the strong views of Britain and the rest of world I do not know, but one certainly hopes so.
	My noble friend Lady Falkner also raised-as did several other speakers, such as the noble Baroness, Lady Kinnock, in her comprehensive comments-the central question of the role of women in building stability overseas, including in Libya and many other areas. The Government have mainstreamed the importance of the role of women in conflict prevention through our national security strategy and our Building Stability Overseas Strategy. I repeat: mainstreamed. Women have a central role in building stability. In line with our national action plan for UN Security Council Resolution 1325 on women, peace and security, we will continue to address violence against women and support women's role in building peace. I do not think there is any ambiguity about that, barring only the concern we all have about the dangers of stereotyping, which I know many women feel strongly about. Barring only that, the commitment to upgrading and opening up the opportunities for women to play their proper and full role is unambiguous, determined and one that we will support with all possible resources.
	The noble Lord, Lord Black, spoke about practical steps towards media and press freedom. These make a great deal of sense, particularly training journalists. I cannot comment precisely at this moment but it is certainly the basis for a good and sensible approach. The noble Lord, Lord McConnell, said we should tackle this area with vigour. I promise him that we are doing that and will continue to do so. The noble Lord, Lord Chidgey, and the noble Baronesses, Lady Warwick and Lady Kinnock, asked about evaluation and monitoring. How do we know that the system works? A lot of money is involved, as the noble Baroness, Lady Warwick, rightly said. Let me put it this way: the strategy is clear, but investments must deliver results while providing value for the UK taxpayer. To ensure this, a new transparent cross-government reporting framework, subject to independent scrutiny, will be implemented to measure and compare the UK's impact across the regions.
	Aspects of our conflict prevention work are being examined by each of the House of Lords Economic Affairs Committee, the National Audit Office and the Independent Commission for Aid Impact. Focusing on upstream prevention is central to the strategy, but, ultimately, establishing the UK's contribution to conflict prevention relies on counterfactual analysis-examining what level of conflict would have been likely without intervention, which is obviously a very difficult assessment to make. That, I hope, meets the concern about the very proper need for evaluation.
	The noble Lord, Lord Hylton, spoke about waters and rivers, a vital and central issue. I have a very long briefing note on the matter which I shall try to impart to him, though possibly not in this debate because I do not want to take all the time available. We understand that the analytical work being undertaken by the South Asia Water Initiative is already yielding benefits by brokering greater information-sharing between riparians on water, development of co-operative research and the development of a Ganga River Basin authority in India. Rivers drying to trickles and causing despair, or turning into raging torrents and causing floods, are obviously a central issue on the international scene.
	My noble friend Lord Sheikh spoke with great authority on Nepal, where he has been recently. It was extremely helpful to have his views. As always, he gave support to a cause dear to my heart, which is the immense value of the Commonwealth network in promoting stability overseas and carrying forward all our programmes.
	The noble Lord, Lord Desai, to whom I have already referred, made a critical remark about fragile countries. If the criteria are to be the rule of law and respect for property, I can hardly think of a single country where that does not apply, including possibly our own. He knows as I do that judging fragility is fraught with subjective standards and is often governed by, to use the words of Harold Macmillan, "events, dear boy, events" which no one foresaw beforehand.
	My noble friend Lord Hussain asked whether we would help in Kashmir. It is our view that this matter must be handled between two great countries, India and Pakistan, and that remains all I have to say on that matter.
	I have already mentioned upstream prevention and evaluation in response to the noble Baroness, Lady Warwick, who was quite right that the issue of corruption is central and must receive our full attention.
	The noble Lord, Lord Stone, knows that I think that his initiatives and what he has already achieved with his colleagues are quite marvellous. We take the view that the private sector should take the lead in these matters, but with DfID's support. I shall look again at his latest set of ideas, which I believe are totally constructive and to be supported in every possible and practical way.
	I have not covered every point that was raised-there is never time-but I hope that I have responded to as many of the very important observations as has been possible. Since the launch of the BSOS, the Foreign and Commonwealth Office-my own department-DfID and the MoD have been working across government and with NGOs and international partners to implement the strategy. Our actions for weeks and months ahead will include establishing an improved early warning system that can inform early action to help prepare for and prevent conflict; putting in place a new £20 million early action facility to speed up support for emerging crises; supporting multi-year programmes through the Conflict Pool; and engaging bilateral and multilateral partners and NGOs, whose support we must have to make real progress in reducing the risk of conflict globally.
	We are committed to drawing in more external expertise and data to challenge, evaluate and strengthen our work. We also look forward to the recommendations from your Lordships' Economic Affairs Committee inquiry into the economic impact and effectiveness of development aid, and to the forthcoming evaluations of the Conflict Pool by both the National Audit Office and the Independent Commission for Aid Impact. A vital element of delivering the BSOS will be working through the multilateral system, with the European Union, the Commonwealth network, our bilateral partners and civil society in all its multiple manifestations.
	At the UN Security Council in September my right honourable friend William Hague emphasised the UK's commitment to conflict prevention: at one end of the spectrum by supporting local upstream conflict prevention efforts, and at the other end, as a last resort, through coercive measures to prevent conflict. In Libya the United Nations Security Council mustered legitimate diplomatic and military pressure to prevent a regime from waging war against its people, and to deter its members from committing horrific crimes. Swift action prevented a major humanitarian catastrophe and saved thousands of civilian lives.
	In Syria, as I have indicated, we do believe that a response from the Security Council is overdue. We have been pressing for it, but it has been blocked in the way I have already described. The consequences of an action would weigh heavily on us if we turned a blind eye to killings, abuses and repression.
	In the margins of the UN General Assembly a week or two ago, I had a number of bilateral meetings with ministers from states who had been through the most appalling periods of conflict, including Algeria, Iraq, and-further into the past, but still very difficult-Azerbaijan. What struck me was the determination of these states to move on from the past and to deploy economic resources as a way of consolidating peace and stability.
	Our European Union partners also have a role to play, and we welcome the Foreign Affairs Council conclusions of 20 June this year, which set out the need for a more comprehensive EU approach to conflict prevention, including the strengthening of early warning and a greater emphasis on early action, such as mediation.
	The strategy recognises the need to strengthen ties with partners, such as Brazil and South Africa. We shall invest greater diplomatic efforts in new prevention partnerships with these countries, and we are already reinvigorating relations with Commonwealth partners. The Commonwealth is an ever more relevant body that can add its collective voice and collective action to the great global challenges that we all face.
	I leave your Lordships with the message that we can all play our parts, particularly the many experts who have spoken in this debate. Your Lordships have an important role in engaging with civil society, and with other parliamentarians through your networks, both in this country and overseas. Through these networks we can help to strengthen partnerships beyond government, supporting efforts to strengthen and develop effective conflict management and peacebuilding capacities. I thank noble Lords for this debate. I am sure that there are one or two questions that I have not covered, but I have covered quite a range. I will always be ready to write to any of your Lordships who have a particular point they want to pursue with me. I thank noble Lords again for an interesting and informed debate, which has raised many issues that can be carried forward greatly to the benefit of our nation and the wider world.

Baroness Falkner of Margravine: My Lords, it has been my privilege to move this Motion. It has been a fascinating debate, and we have certainly heard a diverse range of views, painting on a very wide canvas. I look forward to reading these speeches in more detail tomorrow, so that I can inform myself better.
	In these foreign affairs debates we often have the pool of usual suspects. We all know each other and are enthusiasts for many of the same causes, so it has been particularly gratifying today to see additions to our pool with speakers who are not usually involved in this, from all Benches and from three political parties. I thank all noble Lords who have spoken, and beg leave to withdraw the Motion.

Motion withdrawn.

Social Enterprise
	 — 
	Question for Short Debate

Tabled By Baroness Andrews
	To ask Her Majesty's Government what proposals they have for promoting social enterprise.

Baroness Andrews: My Lords, it gives me great pleasure to open this debate on social enterprise. I am particularly gratified that at this hour on a Thursday so many noble Lords have decided to join it. That clearly indicates that we consider this issue to be very important. Since I tabled the debate some months ago, there has been a cast change. I am very pleased to see that the noble Lord, Lord Wallace, will reply to the debate, and I look forward very much to hearing the Government's response.
	I had hoped to have the debate earlier in the year, but today's debate has turned out to be more timely. We urgently need to discuss the future of social enterprise, particularly in the light of the comments made by the Chancellor at the Conservative Party conference this week about how to revive the economy. My argument is very simple: if the Government were really smart, the Chancellor and his colleagues would engage, as a matter of priority, with the social enterprise sector to provide it with the tools it needs to prompt growth through innovation, enterprise, skills and jobs, particularly in hard-pressed communities. There is not a moment to waste.
	It is fair to say that this country is a world leader in recognising the unique possibilities of social enterprise, whether we are talking about social business or the habit of enterprise, which is clearly now spreading across the whole of the third sector. Over the past few decades we have seen a range of very effective and successful models emerging.
	Some years ago I had the enormous privilege to work with Lord Young of Dartington, probably the greatest social entrepreneur of the previous century, when he was creating the School for Social Entrepreneurs. That was a hugely prophetic idea and one which has not only had great success in this country but has been replicated in other countries. The school and the growth of social businesses in general across the country show how innovation, skills, jobs, enterprise and social solutions can grow modestly but effectively in local circumstances, and sometimes in very unpromising circumstances.
	The evidence suggests that social enterprises can succeed where private enterprise might fail or not entertain the idea of going. That is why, no doubt, in 2010 the Government promised to support the creation and expansion of mutuals, co-ops, social enterprises and charities so that they could have a greater say in the running of public services. It was a brave step forward, but it was not a new idea. My colleague on the Front Bench and I were in a department which committed itself entirely to the promotion of social enterprise. With the New Deal for Communities we saw in very disadvantaged communities across the country extraordinary innovations developing by way of social enterprise. I think, for example, of the Shoreditch Trust, led ably by Michael Pyner, and many different examples across the country. However, more significant than the scale or the diversity of the sector- £20 billion at one estimate-is the rate of growth, the evidence of sustainability and the public support that it commands.
	We hear a lot about how the private sector is the solution to our economic malaise and how it must lead the economic recovery. In fact, the research undertaken by Social Enterprise UK, tellingly called Fightback UK, contains evidence of how, compared with the private sector SMEs, social enterprise shows three times the level of start-ups. It is outstripping private sector SMEs in growth, confidence and sustainability. I give a couple of examples of that. Some 800 social entrepreneurs who have graduated from the School for Social Entrepreneurs generate jobs to the value of £13 million each year-70 per cent of them are in the 20 per cent most deprived communities. Unlimited, another extremely interesting social innovation set up with millennium funding years ago, has enabled the most vulnerable in our society-refugees, no less-to start successful small businesses which address the aspirations as well as the needs of communities which might otherwise be excluded. The problem is that this window of opportunity may now be closing, just at the point when we need new ideas, new energy and new commitment. To quote from the SEC's research:
	"Social enterprises working in public services are drastically low on confidence. A large proportion of these are planning redundancies or turning away from public service markets".
	Across the third sector as a whole, there has been a 5 per cent reduction in jobs just in the past year.
	Social enterprises seem to be facing a perfect storm. On the one hand, they have cuts in public spending and services which have a disproportionate effect on them because they are nearly always outward-facing into the public sector. On the other hand, they have not been equipped with the tools to enable them to compete with a highly capitalised private sector. Specifically, we see cuts in grants but, more critically, cuts in contracts from local authorities and national bodies. There is an absence of strategies or support for local and national commissioning to enable the sector to contribute. There is an increase in demand for local services, which is bound to increase in the next three years.
	So far we have not seen much understanding from this Government of the impact of this and we have not seen a great deal of response to these threats. The Mutual Support Programme announced by Francis Maude in November 2010 has yet to materialise, as has a national programme for third sector commissioning. Therefore, my first question to the Minister is: when will these policies be published and what will they contain, and what impact does he think they will have? On the other hand, all the signs are that, far from public service markets opening up to social enterprise, they are being captured by a small number of highly capitalised large private sector providers. The barriers to entry at the moment are simply too high for even the most efficient social business. The Wise Group, which has an outstanding record of performance, to everyone's dismay lost out to massive private sector providers to deliver the welfare to work programme.
	The Government's health flagship, Central Surrey Health, which is an exemplary social enterprise, lost out to Assura, which is 75 per cent owned by Virgin. If these bodies fail, what hope is there for smaller social enterprises, no matter how good and no matter how efficient? At the same time, they are of course, like other small businesses, being turned down for loans by banks. This week, I understand that a leading social enterprise with £5 million-worth of contracts was refused a £50,000 overdraft to ease its cash flow.
	The Minister may well say that Big Society Capital and social impact bonds give us a way out of all these problems. They will help but they will not solve the structural problems that we are facing. For example, I understand that the pilot which is under way in Peterborough on reducing reoffending has generated partnership but not from the private sector; it is from the charitable sector and charitable investment. Social impact bonds, which are a very important new idea, are very cumbersome and slightly oblique. They will be very slow to deliver, or to understand how to deliver, the long-term complex, subtle problems that they are supposed to be assisting with. I should be interested to know from the Minister what lessons are being learnt from the way that these two initiatives are working so far.
	The diagnosis is fairly simple. If the country is to take advantage of what social enterprise can offer, it means putting the resources, advice and skills into commissioning bodies, whether it is health or social care or crime reduction, so that they can identify, design in and invest in social enterprise. It means recognising the ecology of social enterprise in the system and why outcomes need to be defined appropriately and not by imposing crude regimes such as payment by results on the sector. There has to be a serious and intelligent attempt at dealing with lending and capitalisation. For example, why do the Government not ensure that further investment in the banking system from UK taxpayers will be bound to quotas on SME lending and job creation in the UK's most deprived areas?
	In a very timely fashion, George Osborne came forward this week with seven plans for credit easing to support small businesses. Can the Minister tell me whether this will extend to social enterprise and, if not, why not, and will he be an advocate for extending the principle to social enterprise? It also means supporting the sector itself, enabling umbrella bodies such as Social Enterprise London or the Social Enterprise Coalition to spread and support good business practice in order to jack up competitiveness.
	It means, in short, promoting national infrastructure to extend and exploit the value of social enterprise for social and economic benefit, drawing on local, national and international expertise and knowledge. Those are not my words but those of the prospectus of partnership offered by the University of Plymouth, which is leading the higher education sector in developing social enterprises to ensure that they become more competitive and more sustainable. That is a very progressive move.
	If there were time, we might be able to wait for this to evolve, but there is not time for the economy or for the sector. Capacity and resources are draining away. The exam question for the Minister is: given the expectations raised and the urgency of the situation that we face, when will the Government engage with the sector on these very practical terms so that it can realise its economic and social potential? The Chancellor also said in his speech last week, very loudly and clearly, that he was willing to work with anyone. There are thousands of social businesses and thousands of social entrepreneurs who are willing to work with him. They are waiting for the chance to do so and I hope that he acts now on that opportunity before it is too late.

Baroness Wheatcroft: My Lords, I first congratulate the noble Baroness, Lady Andrews, on securing this debate on what is such an important issue which could be so beneficial to our country. I confess that, over the years, I have learned a bit about entrepreneurs and enterprise, but "social enterprise" was a term with which I only relatively recently became acquainted. I have known many entrepreneurs. Only a few of them would claim to have been social entrepreneurs; some of them probably should not have been let out on civil society.
	Social enterprise is now a growing phenomenon, and we should all be doing all we can to encourage it. Before going more deeply into that, I make a plea that we do not fall into the trap of thinking that if businesses are not social enterprises they are antisocial. From what I hear, someone was coming dangerously close to asserting in Liverpool last week that businesses that were not social were antisocial-not his words, mine. That is misguided. Business generally is a force for good. It creates jobs, produces wealth and provide for our pensions. We are in a terrible financial state at the moment. We need business to help us out. To categorise businesses as producers or predators is simplistic. To suggest that there should be differential tax rates for them is to risk turning Her Majesty's Revenue into an outpost of the Taliban, threatening physical floggings for those companies which flash a glimpse of predatory tendency.
	All businesses should, in one way or another, see themselves as social enterprises benefiting the community not just through various charitable donations but through a wide range of their activities. Nevertheless, there is a special breed of organisation now emerging under the term "social enterprise", and we need to help that sector to grow. The noble Baroness, Lady Andrews, detailed the obstacles that currently face many in that sector. There is no denying those obstacles but personally, given the straitened finances of the country, I do not think that it is such a bad thing if charities step in and invest in those enterprises rather than them having to depend on public sector handouts.
	We also have the Government making serious moves to encourage social enterprise. We heard about the Big Society Bank. It is shaping up now and, through the big society investment fund, has made its first loan of £1 million. By 4 July, the closing date for the first applications, there have been 57 entries. Many of those will receive funding in the medium term from the Big Society Bank. It will have resources of £600 million. That will be leveraged because of the way that the money goes to investing institutions, which will then put that into the hands of the many smaller organisations that are going to do the good work that they can.
	The Government are also making it easier for social enterprises to win public sector contracts. There is a new website, for instance, that speeds up the process. They do not have to go through the early stage application forms that larger contracts require. The Government are also cutting the red tape that is one of the real barriers to small firms generally and social enterprise, too.
	My noble friend Lord Hodgson of Astley Abbots produced a report earlier this year entitled Unshackling Good Neighbours, which was an excellent read. It contended that enterprise and energy, particularly social enterprise, was being held back by a combination of red tape and a bureaucratic wish to cut back risk. In one telling example, he cited the snow code. Some noble Lords may be familiar with the Government's snow code. I recommend it. It says that you will probably not be prosecuted if somebody falls down after you have cleared the ice. That is not the sort of satisfaction that people need. They need to be sure that if they have done their best they will not be dragged through the courts. The whole tenor of regulation at the moment is prohibitive. It does not encourage people to do things. The snow code is just one of the bureaucratic barriers to enterprise.
	To be fair, the Government have put a moratorium on regulation for small firms-the smallest-and that will benefit some social enterprises. They have launched the red tape challenge in an attempt to scythe through all the regulations but the scythe is blunt. We need a stronger weed-killer to deal with this crop that keeps producing new barriers. There are too many regulations. Despite the barriers, community interests continue to generate thriving social enterprises. The registrar of community interest companies now has almost 5,000 companies on his books. They are businesses that are committed to social enterprise and to doing social good, but they can also pay a dividend-a dividend that is capped but nevertheless an incentive for people to invest in them. All sorts of businesses have subscribed to becoming community interest companies. Very few are turned down. One that was, I am told, was a sadomasochistic organisation that claimed that it produced public benefit because it disseminated information. That shows a lack of education in what social enterprise is all about. The Government could spread the word much more than they already do. Jobcentres, for instance, should really be making more of the opportunities that there are for people to launch social enterprises.
	There are other positives that the Government could do without great cost. I refer noble Lords to Robert Ashton, who dubs himself "the barefoot entrepreneur". He has been a social entrepreneur, has written books and comes up with ideas. I shall cite just two of them. He suggests that community interest tax relief should be at the same level at least as that for the enterprise investment scheme. That seems a reasonable suggestion. After all, if you are investing in businesses for the good of the community, why should you not get the same incentives as those who are investing in small risky businesses in the hope of making big profits? Even at a time of straitened finances, I suggest that the Government might want to look at that. His other proposal, which I fully endorse, is that unemployed graduates might be put to work in social enterprises. Before very long the subsidy that they would need would turn into a wage paid for by the social enterprises that they would help to grow. It seems to me that the big society intern programme would be no bad thing.

Lord Bhattacharyya: My Lords, we are all indebted to the noble Baroness, Lady Andrews, for giving the House an opportunity to debate the Government's plans to support social enterprise.
	Social enterprise is a very broad topic. As time is limited, I will focus on one issue that is essential to achieving the Government's ambition: the need for social innovation to drive the strength of social enterprise. Social innovation is a vital yet often neglected component of any social enterprise. It is the development of new technical, product or process solutions to pressing social issues. At the root of any successful social enterprise, you will find social innovation.
	The most famous social enterprise in the world is the Grameen Bank, with its hugely innovative approach to microfinance, but even Grameen faced challenges when expanding its innovation to different environments such as cities. As microfinance expanded, banks struggled to maintain the bonds of trust that sustained the early lending programmes. Indeed, Mohammed Yunus, who was given a Nobel Prize, has criticised the impact some microlenders have had on the urban poor. Yet those people still desperately need capital to improve their lives. Therefore, there is the demand for more regulation but that would not stave off the predatory lenders. This is a challenge only further innovation can answer. You have to find new ways if the old ones are not working. In Britain, there is a tendency to focus on identifying new funding methods, not developing the social innovations which will attract funding. Both are vital.
	Take the case of social impact bonds, which Professor Paul Corrigan has recently argued should be expanded into the NHS. In a recent paper he showed that innovative methods of managing patients with diabetes or severe asthma can reduce costs and A&E admissions. He powerfully argues that bonds can help deliver these changes if the innovation is credible and sustainable. Whether it is developing a better inhaler for severe asthmatics or helping diabetics manage their blood sugar without hospital visits, any attempt to fund social enterprises through mechanisms like bonds will require proven improvements. Bond investors will not be convinced by hopeful assertions. They want hard evidence. This requires investment in the discipline of scientific evaluation.
	This can lead to a Catch-22 familiar to all entrepreneurs: developing an idea into a working product requires funding, yet funders require evidence the product works. As a result, we find many social enterprises travel more in hope than expectation of outside investment. Without support for social innovation, we risk creating wonderful social market models, then finding that no one is in a position to take advantage of them. The Government are taking some welcome steps. The Innovation in Giving Fund is most welcome, as is the Social Action Fund to support structural innovation, and the Big Society Bank.
	However, I am concerned that the initial big society capital proposal suggests that the only innovation the Big Society Bank will be mandated to support is financial innovation. If the last few years have taught us anything, surely it is that financial innovation alone is not a good basis for long-term growth. We should make it a priority to support social enterprises that wish to pursue social innovations. Without support, they will find it difficult to compete with private businesses that can fund research and evaluate new products with superior cash flow.
	If we do not help social enterprises innovate, we risk regularly repeating the recent failure of NHS Surrey to award its community services contract to a social enterprise, as investors or commissioners will worry about the stability of social business models and the quality of social products. The Americans are ahead of us here, with their recently announced Social Innovation Fund. This brings together state, private sector and philanthropic funding to encourage R&D and to rapidly expand innovation in the undercapitalised social enterprise sector. We should pursue a similar initiative in the UK.
	The NHS Social Enterprise Investment Fund might offer a model to expand further; for example, the fund is helping Bromley Healthcare develop ideas like virtual wards to reduce expensive A&E admissions. Beyond the NHS, the UK does not yet do enough to support social innovation, but the capability exists. NESTA, the Young Foundation and the Skoll Foundation are all interested in supporting what you might call social R&D. It is four years since the Young Foundation's report on social innovation was produced and a clear lead from the centre is still needed. Therefore, perhaps I may ask the Minister what plans the Government have to extend the important area of support for social innovators. We could look at how social innovation could help social entrepreneurs to develop products with a clear impact in areas such as accident reduction, child safety or offender management. We are rightly setting up mechanisms that make social enterprise attractive to investors. We must also help social enterprise to develop attractive innovation for investors. We need social innovation to make social enterprise work.

Lord Newby: My Lords, I, too, thank the noble Baroness, Lady Andrews, for introducing this timely debate. I begin with a declaration of interest as the chair of Live Sport Community Interest Company, which provides education programmes to disadvantaged children via the medium of sport, and as chair of the All-Party Social Enterprise Group.
	Previous speakers have already mentioned a number of advantages that social enterprises bring and I should like to refer to three of them. The first has to do with the ethos. The commitment of those who work for many social enterprises is often exceptionally high. The consequence of that is that the productivity of those enterprises is correspondingly high. An example which I have given previously in your Lordships' House is that of Sandwell Community Healthcare Services, which was able to take over services provided by the local authority and to do it for literally half the price. One of the main contributions towards that saving was that the number of days of sick leave fell from 30 to three. It was all to do with the motivation of people who in their previous local authority guise had not been valued or motivated.
	Secondly, social enterprises tend to be extremely flexible, partly because they are small and partly because they tend to have a very flat management structure but they do have the flexibility that one associates with the small business sector more generally. Thirdly, the sector appeals to a new sort of entrepreneur. Many people, particularly young people, want to be exactly the kind of social innovator to which the noble Lord, Lord Bhattacharyya, referred. But they do not want to do it via the medium of a straightforward private sector company or through a public body. They want to have a go themselves. They have an idea and they are just like other entrepreneurs, except that their motivation is towards producing a social good rather than a straightforward commercial good.
	However, the sector now faces a number of problems, to which, to a certain extent, reference has already been made. The first is the problem of scaling up. Most social enterprises are small for a number of reasons. One is that they are typically over-reliant on a charismatic founder. I see a charismatic founder in the shape of the noble Lord, Lord Mawson-sparing his blushes. The challenge is how, as it were, to clone these charismatic individuals who start an enterprise and get it to a certain size, but then find it very difficult to get beyond that size because there are not the support structures that there are around straightforward private sector activity.
	The second general constraint around scaling up relates to finance. There is limited scope for investing in community interest companies bar in a straightforward way because of the asset lock and the limit of dividends. There is an unwillingness in the banks to invest in the sector because it is slightly outside the ordinary. Even in good times, banks find that challenging. At the moment, they find it impossible. So there is an over-reliance on high net worth individuals and charities to fund the sector.
	The good news is that the sector has grown significantly and there is more recognition that value is to be had in investing in it. It will be very interesting to see how big society capital uses its resources and £600 million is quite a nice start. We hope that it will act quickly and that the big banks which have contributed a third of that will be so inspired by what they see that they might get the habit and either use big society capital through which to invest more of their own funds or put money into social enterprises directly.
	There is also quite a lot of activity around more traditional forms of funding. The report commissioned by the City of London Corporation from ClearlySo on investor perspectives on social enterprise showed that there was plenty of scope for progress there. The report produced by my noble friend Lord Hodgson, to which the noble Baroness, Lady Wheatcroft, referred, had the sensible idea of creating a social investor, equivalent to the established concept of an experienced investor, which would make it easier for people to invest in charities and social enterprises. I hope that the Minister will say that the Government support that proposal.
	The other big issue that has been referred to relates to winning contracts, given that a large proportion of social enterprises look to the public sector for contracts. The starting point in terms of problems is that the cost is typically twice as much for public sector contracts as private sector ones. There is a terrific inertia in many parts of the public sector in terms of providers. The sector has a comfort zone of who it likes to give contracts to and is very wary of going outside that, particularly in the risk-averse environment in which we now find ourselves. As the noble Baroness mentioned, large private sector operators have the ability to undercut smaller social enterprises. They have huge resources with which to do the whole bidding process.
	Finally, there are ridiculous delays-I see them myself-between the point at which a public sector body says that in principle it is prepared to let a contract go to a social entrepreneur and then actually signs it and makes the first payment. From my own experience, that sometimes takes well over six months. The social enterprise does not very often have six months of cash flow to cope with that kind of delay.
	What is to be done? First, some social enterprises go on the back of successful private sector contractors for the work programme and other big public sector programmes. They become subcontractors, which is a way forward but not ideal. Secondly, on my point about the timeliness of decision-making, the Government ought to see whether there could be a presumption in terms of making a decision and finishing a contract with a social enterprise-and more generally SMEs-within a certain timeframe. This dragging on, which is now almost an art form in parts of the public sector, is very worrying. Thirdly, I commend the Public Services (Social Enterprise and Social Value) Bill which Chris White introduced in another place last November. It has government support and would nudge local authorities and other public sector providers into supporting social enterprises. Social enterprises do much good work already but they have much greater potential.

Lord Mawson: My Lords, I join other noble Lords in thanking the noble Baroness, Lady Andrews, for securing this important debate. We are all conscious that we live in a world that is quickly changing around us. If you stand still, you can feel as though you are moving backwards. People are no longer willing to accept the same predictable services from the public sector but are demanding higher quality services, more choice and the personalisation of services. In reality, can governments deliver this choice?
	The situation in Europe at present is just one example of political drama that makes people wary of trusting governments. People are sceptical-often with good reason-of politicians who hide behind grand phrases, processes and hubris but take little care of the detail and fail to deliver positive, practical and sustainable action. In the social enterprise sector in Britain at present, I, along with many of my colleagues, welcomed the coalition Government's pledges about social enterprise because they are exactly in the right direction of travel. Yet, worryingly, there is a growing sentiment in the sector that these promises are just not being delivered on and once again governments cannot be trusted to turn rhetoric into reality.
	The coalition Government agreement had two main pledges to support social enterprises in public service delivery. First, they said that they will support the creation and expansion of mutuals, co-operatives, charities and social enterprises, and enable these groups to have much greater involvement in the running of public services. Secondly, they will give public sector workers a new right to form employee-owned co-operatives and bid to take over the services they deliver. This will empower millions of public sector workers to become their own boss and help them deliver better services. Yet, as has been said, the Social Enterprise Coalition, which represents many in the sector, while standing in a slightly different place to me, cannot see at present much support for social enterprises delivering public services. What we all see, they say, is a lot of stagnation: the waters, instead of being clear, are increasingly muddy. The Mutual Support Programme which was announced by Francis Maude in November 2010 has yet to materialise. The national programme for third sector commissioning, a programme designed to support the commissioning of social enterprises and charities, has not emerged.
	Without some intervention, there is a real danger that public service markets will be opened up and dominated by a small number of large private sector providers. The Social Enterprise Coalition says that it has seen this happen in a number of public service markets: welfare to work, waste and others where a small number of private companies dominate and the barriers to entry are too high for social enterprises and other small businesses to operate. There is some truth in this and I know from past experience how government departments love to talk to large bureaucracies because they are adept at using that language. Bureaucracies love to talk to bureaucracies. Talking to small and medium-sized social enterprises is quite a different matter because they speak a different language. We will need more than websites to address this issue.
	Some of us have seen all this before and it requires focused leadership in government to break into the impasse. I am a great believer in the power of the market but sometimes the Government have to intervene to make the market happen. The noble Baroness, Lady Thatcher, knew that.
	There are three ways of governing: the centralised state solution, the market, or the present favoured choice referred to by our major parties as going local. While those of us who have operated at a local level for more than 30 years are tempted to welcome this attention, we worry that politicians on all sides do not actually comprehend a lot of the practical detail. The systems of government and the Civil Service can present themselves as something new but when you actually examine the details, old out-of-date processes and systems still prevail and are in danger of replicating themselves a thousandfold in local communities across the country. On my travels, I keep meeting old men in new clothes. There are real and very practical opportunities to grow the social enterprise sector in the process of going local, but it needs nurturing and it will not happen without the devil in the detail being understood within government.
	If this does not happen, I fear that we will see yet another phase of a very expensive cycle. Vast sums of money are wasted every year by those politicians who do not take personal responsibility, get hold of the practical detail, and drive forward viable change. The public are tired of seeing very little change and know that the processes of government carry on very much as before, regardless of which party is in power.
	There is a challenge here that has not been grasped because there are no particular easy brownie points to be gained by any Government if they grasp this particular nettle. Yet the long-term rewards will be worth the short-term difficulties.
	I welcome both the localism and health Bills, but I ask the Minister what evidence there is that the Government are making life easier for those of us who are attempting to deliver these welcome changes on the ground. What evidence is there that there is a level playing field on which social enterprises can compete with large companies? What practical evidence is there that red tape is actually being removed? I can hear many fine words but outside your Lordships' House, the jury seems to be out on these issues.
	The world may be changing but the systems of government and the Civil Service seem to chug on regardless. Without very clear and focused leadership within government none of this will happen and, as with all recipes, the end result depends upon proper preparation, mixing and baking. No one likes an undercooked chicken.
	This pretence at change will not do for the modern enterprise culture that our children are now growing up in-a culture where at the press of a button you can receive information from anywhere in the world about virtually anything; a culture where young people, through technology, are learning by doing. The public sector still thinks that the world is about process, system and strategy, but our children are growing up in an integrated world created by entrepreneurs like Steve Jobs, co-founder of Apple, who died today, based around people, relationships, practice and networks. These two worlds are fundamentally at odds and I see little attempt to address the issue from any of our political parties.
	The big breakthrough will start to come where social enterprises and business work ever more closely together. My colleagues and I have created a regeneration business, which we have set up as a social enterprise, called One Church, 100 Uses-and I must declare an interest. We have recently moved our head office into the London offices of HLM architects, a business and a well respected firm of architects that operates nationally and internationally. This decision was taken because, as we grow the business, we recognise the potential synergies between us. The development of public buildings over the next decade may necessarily be more small scale with less money about. The churches in Britain own nearly 50,000 buildings across the country, many ripe for redevelopment in favour of the local community. Maybe there is synergy between this business and a small emerging social enterprise. We think there is, and are ready to discover opportunities together. We need to see more partnerships like this in the social enterprise sector.

Lord Wei: My Lords, I, too, thank the noble Baroness, Lady Andrews, for tabling this excellent debate, and declare an interest as an adviser to the Community Foundation Network. Given the limited time we have in this debate, I will not dwell on definitions, even though the term "social enterprise" does differ, depending on whether one uses the more narrow legal definition based on percentage of income earned, or the broader sense of the word, which comprises more a sense of solving social problems in an entrepreneurial way. I prefer to use generally the term "social venture", which explicitly encompasses both definitions.
	There is much about government policy on promoting social enterprise that should be welcomed. Here I must declare an interest in having had a hand in developing some of it. It is particularly pleasing to note that while traditional volunteering and giving may be on the wane, social enterprises have been starting up at an explosive rate since the election. I believe these two trends are actually two sides of the same coin; as we age and as technology changes our lifestyles, it is not surprising that traditional attitudes to giving and volunteering, in which money and work may have tended to be handed over to professionals, are on the wane, and more and more people, old and young, want to give of their time and money in a more hands-on, technologically enabled-that is to say, convenient and, indeed, entrepreneurial-manner. Social enterprises or ventures will be the likely beneficiaries of such a shift.
	Social enterprises facilitate all three parts of the Government's programme of sharing greater responsibility for tackling social problems with citizens, otherwise known as the big society. Social action, community empowerment and public service reform are all made possible through social ventures, and the Government have recognised this, for example through their national citizen service programme, which seeks to engage young people from widely different backgrounds in serving their communities, often through social action-orientated social ventures, or their programme of training community organisers who can help citizens locally develop social enterprises as a means of addressing neighbourhood issues, or through the big society capital wholesale fund, designed in large part to help social enterprises to achieve the scale needed to help compete for and then deliver devolved public services.
	However, despite this great start, more could be done in each domain to encourage social enterprises to thrive. In the area of social action, for example, there needs to be more follow-through on implementing the recommendations on barriers faced by social organisations, including social enterprises or ventures in the report from the noble Lord, Lord Hodgson, Unshackling Good Neighbours, such as redrafting guidance from government departments that can be written in too risk-averse a manner, causing many smaller organisations to be overly fearful of liability and causing them to incur unnecessary costs that they can little afford.
	In the area of community empowerment the Government need to encourage a more consistent treatment of social enterprises by local authorities and front-line officials, which in my view have a very wide range of attitudes to the role of such enterprises locally across the country. In some places, social enterprises are seen as a valued part of the local ecosystem and supported well, whereas in others they are seen too often as a quick way for the local state to offload assets. One low-cost way of achieving this better understanding of social enterprises in the public sector that I have come across is encouraging leaders from the public sector to work in the offices of social enterprise leaders, and vice versa, for parts of their week, which can often help to increase understanding of the challenges and strengths of each others' models and ways of operating, which can then lead to more nuanced policy and co-operation at a local level.
	In the domain of public service reform, there remains a real need to create more of a level playing field in commissioning based on social value, as articulated in Chris White's Private Member's Bill, which was also mentioned earlier. Officials should desist from trying to water down provisions in the Bill for fear that they might complicate tendering processes or lead to economically inefficient decisions. On the whole, seeking social value does not, in my view, have to complicate or render commissioning decisions uneconomical. Rather, good commissioning should always seek to balance complexity and simplicity in the short and long term. Sadly, too much commissioning today seeks to go for the overly reductionist and short-term answer, which too often in turn leads to a lack of the originally desired outcomes and longer-term costs because best value principles were not followed. It is disappointing, for example, to see organisations such as Surrey Community Health not winning tenders and to see the lack of successful bids, so far, from employees in the NHS to form mutuals, which has a lot to do with the way in which commissioning is currently configured.
	I believe that the Government have made a good start in supporting social enterprise and ventures in what are financially difficult inherited circumstances, but the pace has definitely slowed. The Government now need to show how they, too, can be socially entrepreneurial and implement further reforms to build on that strong start-not succumb to timidity or be stymied by bureaucratic roadblocks. To achieve this, they could well do more to work with the likes of community foundations, which are experts in facilitating the start-up, scaling and, increasingly, the turnaround of social enterprises up and down the country. Indeed, the community foundation movement covers about 97 per cent of the country.
	I know from personal experience that there are parts that government ultimately cannot reach and I encourage social entrepreneurs, public servants and commissioners to work with their local community foundations to overcome the barriers that they face in helping to support the social enterprise sector, so that the many promising existing and newly started social ventures can continue to thrive, expand and collaborate, forming together a full part of the ecosystem of players needed, now more than ever, to strengthen our society.

Baroness Randerson: My Lords, as the noble Lord has just said, social enterprise is a very broad umbrella term and we could spend the whole of this debate just defining it. We could mean charities that do some trading or we could be talking about large commercial enterprises that redistribute their surpluses to their employees. Taking the generally accepted definitions, however, social enterprises contribute greatly to our economy. They contribute an estimated £24 billion annually and a consistent 1.5 per cent of our GDP, employing about 800,000 people. That is significant, but it could be much more significant still, so I thank the noble Baroness, Lady Andrews, for initiating this important debate.
	As many noble Lords will know, I come from Wales, and I want to bring to your Lordships' attention one notable example of a social enterprise that flies in the face of the general trend that my noble friend Lord Newby referred to earlier: for social enterprises to be, on the whole, small scale. That pattern is indeed the same in Wales as in the rest of the UK, but we have one notable exception in Wales. That is Glas Cymru, better known to its customers as Dwr Cymru, or Welsh Water.
	Glas Cymru is the only one of the privatised water and sewerage companies in England and Wales to adopt a social enterprise model and is a single-purpose company formed to own, finance and manage Welsh water. It provides services for some 3 million people throughout Wales and in the borderlands with England. It is a company limited by guarantee under the Companies Act and was established in 2001, when it was bought from Hyder plc, a traditional for-profit company. As a company limited by guarantee, of course, it has no shareholders, and its assets and capital investment are financed by bonds and retained surpluses. It is run by a board of members who have no financial interest in the company and receive no dividend. The customers do not own Glas Cymru; it is not a mutual. In other respects it has the same framework as other water companies, but customers receive a rebate on their water bills in times of surplus-and I declare an interest as a Glas Cymru customer. Customers get a good deal with lower bills, and profits are reinvested in capital development for the company.
	When the company gave evidence to the enterprise committee of the Welsh Assembly, it stressed that in its view the model could be replicated elsewhere, and that is my point in raising this today. In its view, the energy market was a prime area for that model; its not-for-profit status has greater legitimacy and greater community involvement than a normal for-profit company. Glas Cymru believes that it is better equipped to make the long-term decisions and investments that are needed in the energy sector than a normal shareholder-owned short-term competitive company. I urge the Government to look at this model with an eye to the energy market as a whole and the renewable energy market in particular.
	It is worth pointing out here that the political support of the Welsh Assembly Government was crucial when Glas Cymru was set up. It could not have been done without that support. The UK Government need to provide that political support if that model is to be replicated.
	That is an example of a large-scale social enterprise, and there are of course others. However, as has been said, the general problem with social enterprises in the UK is the lack of suitable financial models to allow them to grow. There are a number of potential solutions to this problem, and several noble Lords have referred to that. The important thing is that the Government have a crucial role in developing the levers to ensure that suitable finance options are much more broadly available to allow social enterprises to grow and develop. The signs are good and a number of useful options were flagged in the government report on growing the social investment market, which was produced in February this year.
	I shall touch briefly on an interesting option included in that paper: the idea of piloting a social stock exchange or providing incentives for existing stock exchanges to develop an exchange of stocks in social ventures. I believe that there is a largely untapped wealth of interest in investment in social enterprises. Many people would prefer to have a stake in their local community-based business. They are not necessarily interested only in getting the maximum possible profit and, despite being in very hard times now, many people would be prepared to give some of their money to invest in that kind of enterprise, with at least part of their investments going in that direction. I have long had an interest in local stock exchanges generally, and the model suggested in this Cabinet Office report is worthy of further investigation. I urge the Government to pursue it.
	It is important that we move on from supportive rhetoric. We had such rhetoric from the Labour Government prior to the current coalition and it is important that the new Government, who have provided so much leadership on this, now provide some concrete support in the months to come.

Lord Haskel: My Lords, many years ago, I was responsible for installing the first computers in our business in Leeds. They were a novelty. Everybody wanted to have a go and so we opened the office in the evening to staff and their families. Before long we had a little computer training co-operative going, which helped local people, particularly staff members' families, to get better jobs and do better at school. It certainly raised the morale, commitment and loyalty that the noble Lord, Lord Newby, spoke about.
	Was it a social enterprise or a social venture as the noble Lord, Lord Wei, put it? In those days, we socialists-that is what we called ourselves in those days-spoke about common ownership. To most people, such as my noble friend Lady Andrews, social enterprise was contradiction in terms. A few of us were influenced by Michael Young, the social entrepreneur, who convinced us that business was as much about society as profit, as the noble Baroness, Lady Randerson, said. In truth, the name scarcely matters. What matters is that it was right for the time, it was right for the place and it was right for the people. Our little enterprise met the social need for people to become more computer literate: a local and specific social need which we did not even know existed when we started.
	That is the secret of successful social enterprise, and why they are generally small and local. Otherwise they become ordinary businesses and lose their distinctiveness and that special aspect which sometimes enables them to succeed when ordinary business fails. As the noble Lord, Lord Mawson, explained, this is why in practice most big contracts in public services go to large private firms who, in turn, subcontract to local enterprises. This is in spite of the rhetoric from the Government, about which the noble Lord spoke.
	It is easy to be cynical about social enterprises. It is easy to talk about them having mixed objectives and achieving neither. It is easy to talk about them being soft and therefore being crushed in the tough world of business. However, somehow, the idea of social enterprise keeps going. It just reinvents itself and adapts to the changing times. Indeed, its ability to deliver social benefits as well as commercial benefits may be another intangible asset that we have only just rediscovered about modern business.
	The Government are making every effort to promote social enterprise, but they have got some of their thinking the wrong way around. Making 1 million public servants redundant and then trying to persuade them to sell their services back in the form of a social enterprise is getting things the wrong way around. Why? Because nobody is sure what need is being satisfied. Is it cutting public expenditure? Is it encouraging the private sector to provide public services? Or is it social engineering: trying to get people to improve themselves? Perhaps the Minister can clarify this, because until it is clarified it is not going to work properly.
	There is clarity over what the Co-operative and Community Finance organisation is about. It calls itself the "lender for social purpose" and has been doing this for nearly 40 years. It raises money by public share issue and I declare an interest as a long-standing investor. Its prospectus says that it lends money for social purposes and collective benefit. But it is small, not because it has no money but because most social enterprises-apart from perhaps housing, mentioned by my noble friend Lady Andrews, or even water-also have a limited capacity to absorb and justify major loans and equity. Social enterprises have to perform. Their leverage is limited. Yes, we may do business with them initially because we support their social aims, but to get the repeat business they have to deliver quality, service, value, efficiency and profits like everybody else. So they have to be careful with debt.
	Indeed, the big society and other fundraising ideas may not be all that relevant unless the terms on which loans are made are eased, and the need for more formal management is changed. Social investment bonds may be an idea whose time has come-the social investment market is expanding-but these are early days. We will have to see whether they survive the innovation of the City without the social innovation that the noble Lord, Lord Bhattacharyya, spoke about.
	Traditionally, most social enterprises work in towns and cities: housing maintenance and refurbishment, collective living, training, health and welfare, especially for the benefit of those who are failed by the usual system and have particular needs. Interestingly community ownership is moving to the countryside where community-owned shops are replacing some of the many village shops which close each year.
	An article in Tuesday's Financial Times told us that there are 60,000 social enterprises in the country, employing 800,000 people and turning over £24 billion a year. I suspect that figure depends on what you mean by social enterprise, but obviously this is a growing sector-growing in terms of numbers and public acceptability. The concept is being promoted by the Government; it has its own advocacy body, business schools are teaching it and institutions are appointing social entrepreneurs in residence.
	As the noble Baroness, Lady Wheatcroft, suggested, jobcentres could also play an important role. All this is to the good and, like other noble Lords, I hope this is the way business is going. I wish it every success. I also hope it does not allow itself to be taken over by-or become part of-the existing business establishment. It would then lose its distinctive, special and attractive features and that would be a loss.
	I am most grateful to my noble friend Lady Andrews for moving this Motion. It gives us an opportunity to debate some of the better business practices-not social business practices as the noble Baroness, Lady Wheatcroft, suggested-about which my party leader spoke last week.

Baroness Scott of Needham Market: The noble Baroness, Lady Andrews, has done the House a great service by tabling this debate today, which has demonstrated that huge disagreement is not needed for an interesting debate. We by and large agree, but nevertheless there have been lots of different and interesting points. It is perhaps not surprising that we agree because one thing which unites us, wherever we sit, is a sense of public service. That is why we are active in your Lordships' House. It is also why we do what we do outside this House. As we go around the country, the ideal of public service is absolutely alive and well. Everywhere there are people who, in some way or another, devote their life to service to the public.
	Until fairly recently, I regarded public service and the public sector as synonymous. I was wrong and I admit it. I was also wrong to believe-as I did until 1997-that all that was wrong with our public services was a lack of funding. I am sure that privately if not publicly even Members opposite would accept that the large amounts of money put into public services in the last 10 or 15 years have not delivered the outcomes for many of our citizens that we would have hoped. I am not going to theorise why, although I strongly feel that the blame, if you want to call it that, does not usually lie with individual workers. Personally, I deplore the demonisation of people who choose to work in the public sector.
	However, if we are looking for solutions and ways to improve public services, the solutions very often lie with the people who are working within our public services. They are the key to reform and making services more flexible, responsible to individual need and circumstances, locally focused and cost-effective. Last year, I met a former youth worker in Suffolk who had left the county council and set up, almost by accident, a social enterprise. She is doing great things with young people with multiple problems. Local social services had to admit that they had virtually given up on those young people, but that lady has been able to deal with it.
	Earlier in the summer, I met Dai Powell, who runs Hackney Community Transport. Founded in 1982 from very modest beginnings, it now operates across the country and last year provided more than 12 million passenger journeys. Government need to be sure that they know where these existing, very successful models of social enterprise are. Something like Hackney Community Transport should be used as a benchmark for service delivery, because it is not only cost-effective and efficient but also ethical and locally responsive. It would make a change for government to benchmark against that rather than conventional service delivery.
	In this current economic climate, as we have heard, there is a great incentive for this sector to grow, but the danger is that it is seen as some way of getting public services on the cheap, which it certainly is not. Nor will this growth somehow happen all by itself. Some will of course, but if we are to see the step change that the Government seek, then the Government have to get serious about it.
	How do they do that? First, they have to play their part in creating a culture in which social enterprise is seen as a serious career option for people leaving education and for those looking for work, and not as some sort of last resort of employment. In this regard, Ministers' attitudes are crucial both in terms of saying the right thing and ensuring that social enterprise is seen as an intrinsic part of service delivery and not bolted on as an afterthought. It needs to be mainstreamed into all policy and legislative decisions.
	Secondly, the sector needs support. I recently spent a very enjoyable day with the School for Social Entrepreneurs in Ipswich, where I met a variety of people seeking to set up social enterprises. Their dedication and enthusiasm will carry them a very long way, but professional support in finance and business planning, legal frameworks and so on is key, and this is where the school comes in. The Ipswich school is great, but we need more of this sort of thing right across the country. We also need social enterprises which themselves help other social enterprises. My colleague in Suffolk, Craig Dearden-Phillips, does this very well through his business, Stepping Out. Social enterprises need help not only in being established but in scaling up, as my noble friend Lord Newby, said, although not every social enterprise wants to get bigger-that is precisely the point.
	If services are to be divested from local authorities or health trusts, it is senior managers from those bodies who are likely to head the social enterprises. If they are to make the transition from senior manager to chief executive, they will need help in doing so. Social enterprises continually cite public procurement policies as a major obstacle to growth. The Government need urgently to address that.
	For many years now, local authorities have been encouraged to join together to create purchasing consortia to benefit from economies of scale from larger contracts, but this simply has the effect of freezing out new providers who are smaller and in the long run generates higher costs by driving diversity and competition out of the market.
	Traditional procurement and commissioning tend to focus on hard financial data and lose sight of those rather harder-to-measure aspects such as advocacy, support and accessibility-those things which make social enterprise so attractive.
	The Government have to give serious thought not to giving a handout to this sector but to giving it a step up, perhaps by thinking about quotas for the transfer of services or, as my noble friend Lord Newby said, about speeding up the process, which is so protracted that it stymies local initiative. Starting a new social enterprise is a huge risk for the individuals concerned. They need assurances over length of contracts and the future of the pensions that they have built up while working in the public sector.
	The other major problem, which a number of noble Lords have addressed, is finance, both in terms of availability and affordability. A policy of credit easing-or whatever we call it- needs to be extended to mutuals and social enterprise.
	Social enterprise has so much to offer us in terms of value for money, flexibility and genuinely responsive public services. The track record of such organisations in some of the poorest and most deprived parts of our country is already impressive, but we can do so much more to unlock the energy and enthusiasm of all these people who are genuinely committed to public service.

Lord Hunt of Chesterton: My Lords, I am grateful to be able to speak in the gap. This is a most important debate, led off by the noble Baroness, Lady Andrews. I was head of the Met Office, an example of a large public sector operation, which relied hugely on community involvement. In fact, many of the community activities supported by this big public body then led to local enterprises. Community projects in the environment lead to tremendous skill and know-how, and I sometimes think that the Government should encourage protest as a way of developing great expertise and local activity. Some of these have become quite successful businesses and social enterprises.
	My other point is that it is very important that the government agencies that are interacting with these local groups, and encouraging them, do more to publicise them. We should not denigrate the role of the internet; it can play a tremendous role in explaining what is being done, and it enables other countries to see what is being done here, from-as one might say-an export point of view.
	However, one should not ignore that some complex local community exercises involving health and businesses and local communities can be publicised, for example, on London buses. For instance, these tell you what to do if you are suffering from air pollution and are dealing with your local doctor, and want to get very specific local information. Indeed, it was rather disappointing that the Cabinet Office did not, in describing the scheme this year, describe all the aspects that would be possible. There is more to be done by central government and large corporations to help social enterprise.

Baroness Smith of Basildon: My Lords, I have greatly enjoyed this debate. The expertise and support in your Lordships' House is one which the social enterprise sector will be immensely gratified by. I congratulate my noble friend Lady Andrews on procuring such an important debate, and making such a powerful case. She and others have pressed the Government to match words with deeds. I should declare an interest as a member of the Co-op party, and that I sit as a Labour and Co-op Peer in your Lordships' House.
	No definition is going to be exact, but I always think of social enterprise businesses as those with a heart as well as a head; businesses where profit is measured not just in financial terms, but in how it benefits society. An expression I often use is of businesses that aim for a triple bottom line: that is, good for its business and employees, good for society and good for the environment-in shorthand, perhaps, good for people, profit and the planet.
	How that profit is used is absolutely key. Social enterprise's prime objectives are social and/or environmental. That is not in any way critical of other businesses that have social objectives, but what gives social enterprises their distinctive character is that their social or environmental purpose is their primary purpose, and profits are reinvested in the business. The beginnings of social enterprise can be traced back to the Co-op's Rochdale Pioneers of the 1840s, which led to other co-operatives and social enterprises being set up in what is now a worldwide ethical movement.
	I should confess to your Lordships' House that my last ministerial position in government was at the Cabinet Office with responsibility for social enterprise, including seeking to establish what was then called the social investment wholesale bank, bringing new finance to social enterprise. Delighted as I was to hold that brief, I never really thought that social enterprise sat well in the Cabinet Office, with what was then the Office of the Third Sector and is now the Office for Civil Society. Social enterprises are businesses-as we have heard, very successful businesses-but with a wider definition of what means success in business.
	I was taken by the comments of the noble Baroness, Lady Randerson, about Welsh Water. Indeed, when I was a Northern Ireland Minister, I tried to export the model of Welsh Water to Northern Ireland Water. It has still not resolved the issues there, and it might do well to listen to the comments the noble Baroness made today. Social enterprises are not just about the third sector, and there must continue to be a greater discussion about the role that BIS can play in promoting and supporting social enterprises. I found my meetings with Business Ministers invaluable, and I hope that co-operation is continuing, and expanding.
	Although I am consistently impressed by social enterprises, I also get frustrated-that frustration has been illustrated in other comments today-that those in charge of procurement choose not to recognise, or just do not understand, that they could take into account the wider benefits that a social enterprise can bring.
	I do not know whether your Lordships are hearing the same "dentists' drills" as I am and whether their teeth feel as uncomfortable as mine on hearing that sound.
	The previous Government set up a Cabinet committee, of which I was a member, with the exciting title of "Miscellaneous 37", to address some of the issues around procurement. Many of these issues also affect small businesses. As the noble Lord, Lord Haskel, highlighted in his very knowledgeable speech, too often social enterprises have lost contracts to larger businesses which, although delivering on price, may not provide the added value or success of a social enterprise. Those larger businesses then sometimes subcontracted the provision of services to social enterprises. That cannot be right. Often a social enterprise has provided a service at a far lower cost than that for which the original contract was awarded. All we were seeking to do was to ensure a level playing field so that one sector did not have an automatic built-in competitive advantage over another.
	This is a difficult area but one in which we were making progress. However, the new Conservative Government-sorry, coalition Government; that was a genuine error-went further. Francis Maude, as the Cabinet Office Minister, said in November 2010 that millions of public sector workers-the noble Lord, Lord Mawson, referred to this-would be given the opportunity of,
	"spinning themselves out of the public sector, and taking control of their lives and of the services they provide".
	However, he rather unexpectedly added that this "right to provide" public services would in some cases,
	"see services handed to new social enterprises without the need for a competitive tender".
	As an example of extending this brave new world, he cited Central Surrey Health. Other noble Lords have mentioned that. That organisation was set up in 2006 under a Labour Government. Two former directors of the local primary care trust launched a social enterprise with 650 nurses and therapists who each had a £1 not- for-profit share in this new business. They provide services for the PCT. Although it has not been free of criticism, as is the case with all new businesses, it is highly regarded. It is clear that staff motivation and enthusiasm is second to none. Any profit made is reinvested in local services. Francis Maude was enthusiastic, saying, "They are my poster people". Therefore, your Lordships will understand how expectations in the sector were raised by these comments, especially as regards the tendering process. When so many charities and voluntary organisations were worried about their services in the face of government cuts, many saw this as a potential lifeline. However, when a major new contract came up in the neighbouring area, it was not Surrey Health-the social enterprise "poster people"-but a private company, Assura Medical, 75 per cent owned by Virgin, that won the contract. The noble Lord, Lord Mawson, also referred to that.
	I use this example to highlight the great difficulties for social enterprises in bidding for such contracts on a level playing field. Uncertainty was also created for employees leaving the public sector to join a social enterprise. Instead of "not having to tender", as referred to by Francis Maude, they can later lose the provision and control of that public service to a private company in a way that was never initially intended. We all want to avoid another Southern Cross situation occurring.
	The central point is the need to take into account the wider social and environmental benefits as part of the assessment process. Other noble Lords have referred to this as being an important way forward. It is also about improving the capacity to bid, providing support and assisting possible social enterprise consortia, such as was previously done through Futurebuilders. The consensus in your Lordships' House is that social enterprise is not a political football to speak warm words about and then fail to deliver on when in government.
	I was struck by the comments of the noble Lord, Lord Bhattacharyya, on social innovation. It seems to me that it is the crux of the matter. For me the real value of social enterprises, and where they make the most difference and greatest contribution, lies with those which identify a need which is not being met and then devise innovative solutions to meet that need. They also make an enormous contribution to the economy, including employment. We have heard the examples of Sandhurst Community Care and Hackney Community Transport. One of my own favourites is Jamie Oliver's restaurant Fifteen. This is a restaurant that gets young people, many of whom have convictions, to learn a trade and get their life back on track. Divine Chocolate, led by Sophie Tranchell produces first-rate chocolate and, for the first time, ensured that cocoa farms were not being ripped off. It helped to establish a farmer's co-operative in Ghana and today almost every chocolate company in the world is looking to be fair trade. Another of my favourite social enterprises is the Elvis & Kresse Organisation, which, seeing how many fire hoses were going into landfill, used that high-quality and very expensive waste for bags, purses and luggage. It then gave 50 per cent of the profit it made to the Fire Fighters Charity.
	These examples and others we have heard about are truly inspirational. I also urge the Minister to listen to the social enterprise ambassadors. We have heard about these already from the noble Baroness, Lady Scott. They were introduced by the Labour Government and really impressed me. They are not asking for something for nothing. They are not asking for an unfair advantage but they are asking and seeking to grow the social enterprise sector with the knowledge and experience they have. They need recognition of their work and a level playing field that properly evaluates their worth and their value to society so that they can make their contribution to the economy.
	As the noble Baroness, Lady Andrews, made clear, the danger is that we have lost so many of the programmes that support social enterprises; and government announcements are not yet anything more than that. I hope the Minister will be able to positively address the questions of the noble Baroness, Lady Andrews. If the banking crisis and recession has taught us anything it should be about values. The cheapest is not always the best and value for money can be achieved in more ways than one.

Lord Wallace of Saltaire: My Lords, I thank noble Lords for the immensely valuable and expert contributions to this debate, including the speech we have just had from the noble Baroness, Lady Smith of Basildon, who has reminded us that there is a great deal of continuity between what this Government are determined to do and what their predecessor was determined to do and in the obstacles faced by the last Government and this Government.
	I thank the noble Baroness, Lady Andrews, for the debate and remind her that I was happy to show her around Saltaire last summer. I often think that Saltaire is in many ways an easy and ideal community, not only because is it a very beautiful village in which the Guardian outsells every other newspaper, and partly for that reason untypical, but because it is full of self-motivated people interested in public service naturally taking part in local activities. I only wish that was common across the whole country. Part of the problem that we face, in answer to the noble Baroness, Lady Scott, is that we do not have, across the entire country, the same level of motivation or willingness to participate in local public community life that we want to generate. That is part of what this Government are now attempting to do.
	We support social enterprises because these are now integral to a more active, fairer and more prosperous society. We see social enterprises as ways of supporting citizens in communities to take more power into their hands and to build what the Prime Minister calls the big society-a more engaged and less passive society. Social enterprises are also an important part of a business community that contributes to our economic prosperity. I take the question asked by the noble Lord, Lord Haskel, about how one defines the extent of this large and rather amorphous area, but the estimate that the social enterprises employ 800,000 people and generate 1.5 per cent of GDP is a fair rough estimate that suggests, as we expand this sector, how very useful it can be.
	We are supporting social enterprises as far as we can across the whole of government, from pushing through mainstream reforms to recognising the potential of social enterprises, by making it easier to start up and run social enterprises by leveraging resources, by increasing the opportunities and support to help social enterprises grow and by promoting social enterprises in the public sector and beyond. We all recognise how large a task this is and we also recognise how diverse a sector we are talking about.
	Some of us have been talking about community assets-local shops, pubs, community halls and grounds. I can think of at least two Members in this Chamber whom I know well who are involved in the setting up and management of community shops. I am very sorry that the noble Lords, Lord Morris of Handsworth and Lord Jay of Ewelme, are not here to take part in this debate today. I have enjoyed talking with them about how they have got involved in regenerating that sort of local community asset. We are also talking more about community interest companies and non-profit organisations which are providing employment and socially valued services. I am familiar with the Cellar project in Shipley, which helps to provide a route back to employment for people who have suffered mental health problems and, in the process, generates a certain amount of income for itself and gives people confidence back in their ability to work.
	We are also talking about mutual providers of public services. I have spent some time during the past year with an excellent charity in Yorkshire, Together Women, which has been dealing with first-time women offenders and has had enormous success in reducing the rate of reoffending among women. However, it is dependent on grants from central government and has not yet been able to move, because central government is not doing it yet, into the social interest bonds where it can say, "We are saving you money, so let's have a different sort of contract from being dependent on central government grants"
	We recognise the enormous obstacles that we are facing. Many of our citizens are still very passive. They talk about their rights; they expect services to be provided; but they do not understand that they need to take a much larger part in providing those services among themselves-sometimes preferring to complain rather than to share public responsibility. The government documents that I have been reading as I have read myself into my new responsibilities talk a great deal about encouraging a widening of neighbourhood councils. I am conscious that neighbourhood councils are not easy to set up in some of our cities and in a number of our smaller towns. Regenerating the self-confidence and self reliance of local communities is itself a long-term project. The previous Government did some work in that area; we are continuing it. It is a long-term task.
	We are talking about a wider attitude change towards public life, public responsibilities and public engagement in self-government at the local level. Having said that, we are also talking about a broader attitude change. Central government, as a number of people have remarked, often resists the idea that you can really trust local people to run things in their own way. The national media lumps the term postcode lottery on anything that appears a little odd, a little more diverse. Business, especially in the financial sector, should not simply be thinking about its responsibilities to shareholders on a quarterly and annual basis. They should also be thinking about people in local authorities and citizens.
	The noble Lord, Lord Wei, and others, have talked about the problems of commissioning. The assumptions underlying commissioning showed that there are real problems with people in central government not yet having thought through what sort of different approach we need.
	Increasing investment under the big society capital approach is part of how we are attempting to change the way in which the sector is funded and to transform its relationship with government and public services. The Big Society Capital Group will be at independent financial institution that aims to increase investment in social enterprises. It will do that by supporting organisations that invest in the sector and will be a champion for social investment with policy-makers, investors and stakeholders in the sector and the public at large.
	Of course, this is not the ideal time or circumstance in which to encourage new enterprises to grow, so provision of diverse sources of funding is extremely important to all of us. The national survey of charities and social enterprises last year showed that just over one-third of those charities and social enterprises surveyed received some form of funding from central government. So this is not a universal problem for the sector. Community foundations have been mentioned and other sources of funding are also important. Too much dependence on the state and on the central budget has not been good for the voluntary sector. Our aim is to reduce that over the long term, to move towards local contracts and contracts for services provided, and as far as possible, to foster self-generating and self-funding activities where appropriate.
	We thoroughly agree with the noble Baroness, Lady Wheatcroft, that business is generally a force for good, but there are issues when one is also looking for a culture change. I am conscious that in the pub sector, for example, the role of the pub companies and of some venture capital trusts has been very much to damage the provision of the availability of community assets for local communities and indeed, to attempt to buy up small breweries for their property assets and then close them.
	I am happy to say that my pension fund, the University Superannuation Scheme, is actively taking part in seeing how far pensions can provide social enterprise funds. We all need to be thinking about that sort of thing, or those of us who are a little involved in what our pensions should be doing. The noble Baroness, Lady Randerson, talked about other forms of providing financial social capital, so to speak. We want to encourage closer co-operation between business and social enterprises and between business and the whole voluntary non-profit sector.
	The noble Lord, Lord Mawson, talked about the barriers to entry. That again is an area that we need to keep pushing to ensure that central government does not go for the easy aim. Nearly 300 welfare-to-work contracts have been awarded to voluntary sector providers. Of those 300, two have been large-scale contractors, and the other 289 are subcontractors. So we have been making some progress in this regard.
	On the question of red tape we are also moving ahead. The noble Lord, Lord Hodgson, has made some 17 regulations in his report, some of which we can do something about. The Association of British Insurers has now moved on the question of ensuring that volunteers do not have to pay more for their car insurance if they are using their car to assist in voluntary activities. That is a useful, small but important step forward. The Payments Council has similarly announced that cheques will now be retained for as long as they are needed. There are a number of small things like that that can make a difference to local enterprise activities.
	On the social impact bonds experimentation in Peterborough, the Government intend to build on that with four more pilot social impact bonds that aim to help troubled families in four local areas. We are moving forward on that and it is seen as a success. We are therefore pushing forward on a range of different fronts: social investment; the new big society capital enterprise; and other means of support for this very important sector. It will take some time and means a whole range of changes at different levels. The most important level is to get more back down to the local level, to get more local engagement. Social enterprises, the Government believe, are vital in their contribution not only to economic growth and employment but to a fully participating society.
	We have made our support for social enterprises a key element of different parts of this Government's programme and we have a strong package of market and individual enterprise-level policies that we hope will help social enterprises to start up and grow. I finish by again thanking the noble Baroness, Lady Andrews, and to say that we all need to keep pushing on this. We all recognise the cultural and mindset obstacles that we face at all levels of government: the economy, business and ordinary people themselves.

House adjourned at 5.44 pm.